How to Choose a Medicare Prescription Drug Plan in 5 Steps


It’s important to remember that the drugs covered and the costs you pay under Plan D can change year to year.

You’ll need to be aware of your prescription drug coverage, whether you are new to Medicare or an existing beneficiary preparing for the annual open enrollment period that runs from Oct. 15 to Dec. 7.

Part D, the Medicare benefit that pays for prescription drugs, is administered by private insurance companies. People with Original Medicare (government-administered parts A and B) may purchase a stand-alone Part D plan to help with prescription drug costs.

Private insurance companies also manage the majority of Medicare Advantage plans. These plans include Medicare Part D prescription drug coverage. Individuals who are not eligible for Part D coverage under Medicare Advantage plans may be able to purchase a standalone Part D plan.

It is important to understand the coverage of the medications and the differences in the cost of those medicines from one plan to the next.

What Medicare Part D Covers

Medicare drug plans include generic and brand-name drugs. Medicare sets a minimum level of coverage for all plans. They must cover the same types of drugs as Medicare, including asthma and diabetes medications. However, plans can select which drugs are included in each drug category.

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Each Medicare Part D plan lists the drugs it covers in what’s called a formulary. Your medicine may not be included in a specific formulary, but it may contain a similar option. Before you start your plan search, it is a good idea to talk to your doctor to determine if there are any other options.

The cost of your drugs, like formularies, can vary between plans based on copays and tiered pricing. To find the best plan for you and your family, it is important to thoroughly research all your options. Sue Greeno, advocacy specialist at the Center for Medicare Advocacy, says that many people stick with what they have, even though there are better, more affordable options. These five steps will help you in your search.

Keep up-to-date with your current plan

Your plan will send an annual notice of change each year in October. You can also find this information on the website of your insurer. Greeno suggests that everyone carefully read the document and verify the following important information:

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Use the Plan Locator

Because plans can change each year and because new plans become available each year, it makes sense to shop for the best Part D coverage for you during each annual Medicare open enrollment period.

The Plan Finder can help. The Centers for Medicare & Medicaid Services have added new features to the Plan Finder tool. This makes it easier for you to find out if your medications are covered, which pharmacies are available near you, and what your total out of pocket costs will include copays.

Other restrictions may be available

Prescription drug coverage can come with additional restrictions, such as tiered pricing.

Learn about the exemption process

Patients will often experience an unexpected health condition that affects their prescription drug requirements well into the next calendar year. This may include a prescription not covered by their plan. Sometimes, patients will find that a covered drug is no longer effective and need to switch to a cheaper version or one not included in their plan’s prescription.

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Enrollees may file for an exemption in these cases with the assistance of their doctors. Greeno states that most insurers will grant exemptions. However, it is another hurdle patients must go through. Make sure you understand how the Part D plans you are interested in work.

Ask for help

Even those with minimal drug requirements may find it difficult to compare the different options. You can get help with the process through your local State Health Insurance Assistance Program, so find the SHIP nearest you. Greeno recommends that you contact your local senior center to get assistance. Often staff can assist in open enrollment questions or will know a good resource. Keep in mind, however, that these connections are only possible for now due to COVID-19.