How do I compare Medicare private drug plans?

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Before you start looking at plans:

 

  • Make a list of the medicines you take and how much you currently pay for them. You may want to ask your doctor for help.
  • Make note of pharmacies you use regularly.

     

There are two types of drug plans you can choose from depending on how you get your Medicare benefits. If you have:

  • Original Medicare: Choose a stand-alone prescription drug plan (PDP) if you want to continue to receive your other health benefits through Original Medicare.
  • A Medicare private health plan (such as an HMO or PPO): Generally, you must get Part D drug coverage as part of your private health plan's benefits package. (If you join a Medicare Medical Savings Accounts (MSA), Private Fee-for-Service (PFFS) plan without drug coverage, or a Cost Plan, you can also join a PDP.)

Get the facts before you enroll in a plan! Here are some questions to ask.

Covered drugs:

  • Does the plan cover all the medications I am taking?
  • Does the plan cover the most important medications I take? (Ask your doctor.)
  • If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)
  • Does the plan require that I get special permission before it will cover the medication I need (such as prior authorization or step-therapy)?

Cost:

  • How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need? (Certain drugs may have high coinsurance.)
  • If a drug I take has a very high coinsurance, is there a drug I can take that will cost me less? (Ask your doctor.)
  • How much will I pay in monthly premiums and annual deductible?

Pharmacy network:

  • Can I fill my prescriptions at the pharmacies I use regularly?
  • Can I fill my prescriptions when I travel?
  • What happens if I go to pharmacies that are not in the network?
  • Can I get prescriptions by mail order?

Coordinating with your other benefits:

  • Will the Medicare drug plan work with my current drug coverage?

 

 

 


Related Questions
Can my state give me more rights and protections than federal law regarding Medigap plan enrollment?

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GO TO
How do I apply for Extra Help to pay for Medicare's prescription drug benefit?

How do I enroll in the Medicare prescription drug benefit (Part D)?

Should I enroll in the Medicare drug benefit (Part D)?

 
LINKS
Medicare.gov

Social Security Extra Help Application

MyMedicare.gov: Access your Medicare information

 
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