Questions to ask when comparing Part D plans

When you are choosing among Part D plans, here are some questions to keep in mind. Before you start looking at plans, make sure you know:

• The prescriptions you take, including their dosages and usual costs (you may want to ask your doctor for help creating a list)
• The pharmacies you regularly use

Drug coverage

• Are my prescriptions on the plan’s formulary formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. ?
• Does the plan impose any coverage restrictions, such as prior authorization prior authorization Prior authorization, also known as pre-authorization or pre-approval, is a restriction placed on coverage by Part D plans and Medicare Advantage Plans. If a service or drug requires prior authorization, you must first get approval from the plan for it to be covered. If you fail to get prior authorization before you get the service or drug, your plan generally will not cover it. or step therapy step therapy Step therapy is a restriction placed on drug coverage by Part D plans and Medicare Advantage Plans. Before your plan will cover a drug, you must first try a different or less expensive drug that treats your condition to see if it will be effective for you. ?
• If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)

Costs

• How much will I pay at the pharmacy (copayments or coinsurance coinsurance The coinsurance is the portion of the cost of care you are required to pay after your health insurance pays. Usually, it is a percentage of the approved amount or negotiated amount. In Original Medicare, the coinsurance is usually 20% of Medicare’s assignment. ) for each drug I need?
• How much will I pay for monthly premiums and the annual Deductible Deductible The deductible is the amount you must pay for health care expenses before your health insurance begins to pay. Deductible amounts can change every year. ?
• How much will I have to pay for brand-name drugs? How much for generic drugs?
• What will I pay for my drugs during the coverage gap?
• If a drug I take has a very high coinsurance, is there a drug I can take that will cost less? (Ask your doctor.)
• Am I eligible for Extra Help or a State Pharmaceutical Assistance Program (SPAP)?

Pharmacy network

• What is the service area service area The service area is the geographic area where a Medicare Advantage Plan or Part D plan provides medical services to its members. In many plans, the service area is where your network of providers is located. for the plan?
• Can I fill my prescriptions at the pharmacies I use regularly?
• Can I fill my prescriptions when I travel?
• What will my coverage options and costs be if I visit out-of-network out-of-network Out-of-network means not part of a private health plan’s network of health care providers. If you use doctors, hospitals, or pharmacies that are not in your Medicare Advantage Plan or Part D plan’s network, you will likely have to pay the full cost out of pocket for the services you received. pharmacies?
• Can I get prescriptions by mail order?

Coordination with other insurance

• Will Part D work with other coverage I have to lower my costs?
• Do I need to enroll in Part D if I have other creditable coverage?
• Do I need to enroll in Part D if I have job-based drug coverage?