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What is the best Medicare Part D Plan?

Which Medicare Part D Plan is best for you will depend largely on your own situation, including where you live, the number and type of prescriptions you have, and which aspects of a plan you want to prioritize. On average, Medicare beneficiaries will have their choice of about 20 standalone Part D plans and over a dozen Medicare Advantage Plans with prescription drug coverage in their area. The Medicare website has a tool that can help you discover and compare the plans available in your area. It lists the premiums for each plan as well as providing personalized information about the out-of-pocket costs you can expect to pay for your prescriptions and the total cost you can expect for the year. Each plan is also assigned an overall star rating which reflects the level of coverage offered as well as complaints, quality of customer service, and more. From the initial list provided, you can select a few plans at a time and get more in-depth comparisons with additional details, such as the monthly cost of your prescriptions under each and whether there are preferred pharmacies in your area. Below is a list of specific points to keep in mind when comparing and choosing your coverage. Those who would like personal assistance in choosing a plan can get help from their State Health Insurance Assistance Program (SHIP) or contact Medicare directly with any questions.

Costs

When analyzing costs, it can be tempting to focus on premiums and deductibles, but it is important to take other factors into account as well. For example, a plan with a high deductible may have comparatively low copayments or coinsurance and thus cost less in the long run than a plan with no deductible. When using Medicare’s online tool, it is generally best to begin by comparing plans according to their total annual costs and then focus on specific details once you have narrowed down your options. It is also a good idea to think about what your priorities are and what you most want to get out of your plan. If most of your medications are generic, look for a plan that divides things into tiers, since generic drugs are usually on lower tiers and will have very affordable copayments. If you are getting insurance more for peace of mind than because you have a lot of prescriptions to cover, you may prioritize low premiums. If you want to keep your costs as even as possible over the course of the year, you may consider plans with low – or no – deductibles. And if you like the convenience and reduced cost of having everything bundled into a single plan, you may want to get a Medicare Advantage Plan with prescription drug coverage rather than a standalone Part D plan.

The Coverage Gap

Anyone worried about facing prohibitively high costs should look for plans that offer extra coverage in the coverage gap – the period of time after your non-premium expenses for the year have reached $3,820 or more but before you qualify for catastrophic coverage, during which you will have to pay higher cost sharing on your prescriptions. You can reduce your chance of falling into the gap in the first place by comparing plans based on the tool’s “Estimated Full Cost the Plan Charges Medicare for Your Drugs” category and looking for plans that remain below the $3,820 threshold. Switching from using brand-name drugs to their generic counterparts can help in bringing costs down to this level.

Formularies

If you take specific drugs, you should pay close attention to each plan’s formulary – that is, the list of drugs that the plan will cover – and be sure that it includes everything you need. When using the plan comparison tool on Medicare’s website, be sure to enter information for each and every one of your prescriptions, including things like dose, frequency, amount needed, and so on. Drugs not included as part of a plan’s formulary will cost significantly more than those that are included, and as a result, failing to leave out even one medication can dramatically impact which plan is the most cost-effective for your needs. Be sure to compare the cost of your prescriptions under each of the plans you are looking at as well.

Pharmacies

While it may seem like a minor detail, which pharmacy you choose to visit can significantly impact the amount you pay. Part D plans make special arrangements with certain pharmacies, known as “Preferred Pharmacies”, which lead to lower costs at these locations. The plan comparison tool on Medicare’s website will ask you which two pharmacies you would most like to receive your prescriptions from and allows you to compare the prices you would pay at each. Because of the potential cost differences between preferred and non-preferred pharmacies, it may be a good idea to re-submit your information using additional pharmacies in the area to help you find the one that offers the best price. When comparing individual plans, you should also be able to see whether those plans have preferred pharmacies in your area.

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