How do I compare Medicare private drug plans?
Section VI.c. Enrolling in Part D and Changing Drug Plans
Question 6 of 9 (use "Last" or "Next" buttons to see more)
Last Update: April 28, 2008
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.
Use the chart in the Related Documents box.
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?
- Will I have to pay the full cost of my drugs at some point after the deductible (coverage gap)?
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?
- Will the Medicare drug plan work with my current drug coverage?
Get information about Medicare drug plans by searching Medicare.gov (click on the link in the LINKS box), calling 800-MEDICARE, or calling the plans directly.