If you’re wondering how to choose a Medicare drug plan that works for you, the best way is to start by looking at your needs and priorities. Choosing prescription drug coverage isn’t the same as buying other types of insurance, because medical needs are constantly changing. Before you decide on a plan, ask yourself these questions in order to make the best decision for you!
Do I take specific drugs?
High prescription drug costs are becoming an increasingly large burden on seniors. More than 66 percent of all U.S. adults take prescription drugs, and according to SingleCare, a health services company, the average American spends approximately $1,200 annually on prescription drugs.
Look at Medicare drug plans that include your prescription drugs on their formulary (a list of prescription drugs covered by a drug plan). Then, compare costs. Check out 10 Ways You Can Save on Prescription Drug Costs and start saving on your prescriptions drugs today!
Do I want extra protection from high prescription drug costs?
If you don’t have insurance or opt to pay the cash price, that doesn’t necessarily mean you have to pay the full price of the drug. Ask your pharmacist or doctor if they have pharmacy discount cards available, or look for ones online that cover the drug you need. Popular pharmacy discount cards include the Medicare Plus Card, GoodRX, US Pharmacy Card, and ScriptSave WellRX.
Look at drug plans offering coverage in the coverage gap, and then check with those plans to make sure they cover your drugs in the gap. Once you reach the coverage gap, you’ll pay 25% of the cost for your plan’s covered brand-name prescription drugs. You’ll pay this discounted rate if you buy your prescriptions at a pharmacy or order them through the mail. Some plans may offer you even lower costs in the coverage gap. The discount will come off of the price that your plan has set with the pharmacy for that specific drug.
Although you’ll pay no more than 25% of the price for the brand-name drug, almost the full price of the drug will count as out-of-pocket costs to help you get out of the coverage gap. What you pay and what the manufacturer pays (95% of the cost of the drug) will count toward your out-out-pocket spending.
Here’s a breakdown:
- Of the total cost of the drug, the manufacturer pays 70% to discount the price for you. Then your plan pays 5% of the cost. Together, the manufacturer and plan cover 75% of the cost. You pay 25% of the cost of the drug.
- There’s also a dispensing fee. Your plan pays 75% of the fee, and you pay 25% of the fee.
Do I want my drug expenses to be balanced throughout the year?
Sometimes it’s easier to pay bills monthly, rather than all at once. For beneficiaries who prefer to pay the same bill every month, you might want to look at drug plans with no or a low deductible, or with additional coverage in the coverage gap.
Do I take a lot of generic prescription drugs?
This is one of the easiest ways to save money on prescription drug costs. Generic drugs are just as effective as their brand-name counterparts, but usually much less expensive. Ask your doctor if there is a generic version of your prescription drug available.
Look at Medicare drug plans with “tiers” that charge you nothing or low copayments for generic prescriptions.
Do I have few drug costs now, but want coverage for peace of mind and to avoid future penalties?
If you have a particularly expensive prescription drug that your Medicare Part D or Medicare Advantage plan doesn’t cover, you may consider switching plans. Do the math and see if the change in your monthly premiums would be cheaper than the monthly out-of-pocket prescription drug costs.
Look at Medicare drug plans with a low monthly premium for drug coverage. If you need prescription drugs in the future, all plans still must cover most drugs used by people with Medicare.
Do I like having extra benefits and lower costs? Am I willing to pick a drug plan with limitations on what doctors, hospitals, and other healthcare?
You might want to consider bundling your healthcare and prescription drug coverage into one plan. Look for a Medicare Advantage Plan (Part C) with prescription drug coverage.
What now?
That was a lot to swallow. Medicare Drug Plans have many variables due to the many medical needs one might have. It is all about understanding your medical needs and finding the best plan according to those needs. Before making a decision, be sure to:
- Get details on how much your drugs would cost under each plan, monthly and throughout the year.
- See which plans put restrictions on any of your drugs (meaning you have to get permission for the plan to cover them) and which offer “preferred” pharmacies that charge lower copays.
- See how Medicare has rated each plan for service (on a scale of one to five stars).
- See alerts that flag low-performing plans.
- Find out which plans are available nationally.
Call Medicare’s helpline. If you call Medicare at 800-633-4227 (available 24/7), you can ask a customer service representative to perform the same search for you. Be sure to make a list of the drugs you take, their dosage, and how often you take them, so the rep can feed them into the online plan finder. You can ask for the results to be mailed to you.
Contact your state health insurance assistance program (SHIP). These state-specific programs provide personal help from trained counselors on all Medicare and Medicaid issues, free of charge. A counselor can use the plan finder to review your options and identify the plan that suits you best. SHIPs go by different names in some states; to find yours, go to the SHIP website and select your state.
This may seem a lot of work, but it’s important to compare drug plans carefully if you want to find the one that’s best for you. For example, plans can and do charge widely different copays — a variation that in some cases has exceeded $100, $300 or even $500 for a 30-day supply of the same drug, analyses have shown. Ideally, you need to do this comparison every year during Medicare open enrollment (October 15 to December 7) because plans can change their costs and formularies (the lists of drugs they cover) every calendar year.
