Healthcare Educators


How to Assess Medicare Part D Drug Plans

by | Oct 2, 2019

As you know, prescription drugs are expensive.  If you’re over 65 or you have a qualifying condition, however, you can get some help with that. Thanks to Medicare Part D, some of your medications may be paid for.

Medicare Part D plans, like any other part of Medicare, are approved by the federal government, but purchased from a private insurer. If you’re eligible for Medicare, you can buy a Part D plan to help cover the cost of your prescription medications.

The question is, which plan should you buy?

There are a lot of options, after all. The Kaiser Family Foundation counted 901 prescription drug plans available this year nationwide, and they’re not nearly all alike. Depending on the plan you choose, your medications may or may not be covered, there may be a coverage gap, the deductible may be high or low, and so on.

With that in mind, here are a few tips to help you evaluate plans and pick the one that’s right for you.

1. Look for your prescription on the formulary.

If the plan doesn’t cover your medication, it’s not much use, is it? Start by assessing its relevance to your needs. Note, you’ll want to do this once a year during open enrollment in the fall, because the list of medicines (also called “formularies”) that a plan covers may change from year to year, AARP said.

2. Mind the (coverage) gap.

The coverage gap is the period of time before you qualify for catastrophic coverage, during which you pay a higher portion of your costs. This phase can be a hardship, so if you’re concerned about cost-sharing, you’ll want to find a plan that offers benefits to see you through the gap.

3. Decide what you can afford.

If you choose a plan with a high deductible, you’ll pay a lot during the first part of the year; then, once the deductible kicks in, you’ll pay less. If that’s a ride you don’t want to be on, look for a plan with no deductible (or with as low a deductible as you can afford).

4. Look for plans with tiers.

Want to save money by using generic prescriptions? Some plans charge a lower copayment (or none at all) for patients who opt for generic medicines. If that’s you, find out if the plans that offer this break have the features you’re looking for.

5. Think about the bundled option.

The one-stop-shop for Medicare is Part C, which bundles A, B, and possibly D into one comprehensive plan. This allows you to get all of your benefits (hospital coverage, doctors and outpatient services, and prescription drugs) through one provider. In other words, while Parts A, B and D are a bit of a buffet, according to AARP, Part C is the “sit-down dinner” of Medicare. However, it may apply some restrictions to which doctors, hospitals and providers you use. Not a problem for you? Maybe Part C is the way to go.

Need Medicare Insurance guidance? PTT Financial agents can help! Contact us today.