Why Your Part D Plan Deserves a Review Every Year
Medicare Part D helps cover the cost of your prescription medications and is offered through Medicare-approved private insurance companies. Coverage may be included in a Medicare Advantage plan or it can be purchased as a separate drug plan alongside Original Medicare.
Because each plan can differ in costs and coverage, it is important to always review your plan ever year. You need to make sure your plan will continue to meet your needs.
Your Prescription Needs Might Have Changed
The prescriptions you are taking right now may be different from the ones you were taking when you first chose your Part D plan. This difference can be a new medication, dosage change, or even the decision to stop taking a prescription altogether. This all can affect whether your current plan still meets your needs.
This is why your current medication list should guide your annual Part D review.
Checking your coverage against each prescription you currently take can help you understand whether your plan remains a good fit for the coming year.
Your Plan's Formulary May Have Changed
What is a formulary? This is the specific plan's covered list of medications. Each Part D plan has a formulary. While all Part D plans must cover a wide range of medications, the exact medication covered can differ from one plan to another.
Plans may also make changes to their formularies when new medications become available or new medical information is released. For example, a plan may add a generic version of a medication and move the brand-name version to a more expensive drug-tier.
Even if all your prescriptions are covered this year, review your plan to make sure they will still be covered next year. And most importantly, see what you may have to pay for them too.
Make Sure You Are Paying For What You Need
It is important to know whether or not your plan covers your prescription, but that is only one part of the review. The tier each drug is placed in, the pharmacy you use, and the plan's different costs can all affect how much you pay.
Drug Tiers Affect What you pay
Many Part D plans place covered medications into different cost levels called tiers. Drugs in the lower tiers generally cost less than drugs in the higher tiers. However, each plan may organize its tiers differently.
A plan's tiers may include:
TIER 1
Most generic medications, usually with the lowest cost.
TIER 2
Preferred, brand-name medications with a medium cost.
TIER 3
Non-preferred, brand-name medications with a higher cost.
SPECIALTY TIER
Certain expensive medications, usually with the highest cost.
The same medications can be placed in different tiers by different plans. When reviewing your coverage, check both whether your prescriptions are covered AND which tier it is in. A higher tier could mean paying more for the same medication.
Your Pharmacy Choice Matters
Where you fill your prescriptions can also affect how much you pay. Part D plans work with certain pharmacies, which are known as in-network pharmacies. Some plans also have preferred pharmacies that may offer lower prices to plan members.
Your usual pharmacy may accept your plan without offering its lowest available prices. Some plans also offer mail delivery or allow you to receive a two or three month supply of certain medications. Essentially this means a pharmacy 5 minutes down the road could be more expensive than one 15 minutes away.
Comparing these options can help you find one that works well for your needs and budget.
Pharmacies outside your plan's network usually cost more as well. In some situations, you may need to pay the full price and then ask your plan whether it will repay part of the cost.
Look Beyond The Monthly Premium
The plan with the lowest monthly premium, or monthly payment, is not always the plan that will cost the least overall. You may also have to pay:
A Copayment
A set amount you pay for a prescription.
A Deductible
The amount you pay before your plan begins helping with covered drug costs.
Coinsurance
A percentage of a prescription's cost.
It is important to consider all of these expenses when comparing plans. A plan with a slightly higher monthly premium may offer lower prices for your prescriptions or better savings at your preferred pharmacy. INSTEAD, try to compare what each plan could cost you over the entire year instead of looking only at its monthly premium.
Make an Annual Review Part of Your Medicare Planning
Your part D plan should continue to work with your current prescriptions, pharmacy preferences, and budget. Even if you are satisfied with your current plan, reviewing it each year can help you understand any changed and decide whether it still meets your needs.
During your review, ask yourself:
Are all my current prescriptions still covered? |
What tiers are my medications in? |
Is my preferred pharmacy part of the plan's network? |
Could I pay less by using a preferred pharmacy or mail delivery? |
What could the plan cost me over the entire year? |
Providing Trustworthy Guidance and Understanding
Trying to sort through medications, plans, pharmacy options, and more can be overwhelming and sometimes confusing.
At MyHealthGap, I work with clients one-on-one and provide independent guidance based on your healthcare needs, doctors, prescriptions, and budget. I do not receive commissions from insurance companies, so my focus is truly on helping understand your options and choose coverage that fits you.
Ready to get started?
Schedule your FREE 30-MINUTE consultation with me at MyHealthGap. Click the link above labeled "Schedule your FREE 30-MINUTE Consultation Here," email me at: amanda@myhealthgap.com.,or call 760.822.3325 to begin.
Together, we can begin sorting through your Medicare options with greater clarity and confidence!
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