During the Medicare Annual Enrollment Period (AEP) How to Compare Part D Prescription Drug Plans
Whether you have a Medicare Prescription Drug Plan (Part D) or prescription coverage through a Medicare Advantage Plan, it is very advisable to evaluate your plan each year to be sure it still offers the advantages you require at a price you can afford. One of the simplest ways to be sure you’re getting the benefits you deserve at a price that works for you is to compare your options during the Medicare Annual Enrollment Period. Plans might differ by cost, coverage level, and quality.
Financial Implications of Prescription Drug Plans
Despite having Medicare Part D coverage, you will still have to pay certain out-of-pocket expenses. Here are some expenses to keep in mind when it comes to your plan, though they will vary based on your plan and whether you receive Medicare Extra Help.
- Monthly Premium – You will also be required to pay a monthly premium for your prescription medication coverage in addition to the Medicare Part B payment.
- Annual Deductible – This is the sum you must pay before your insurance plan starts to cover its portion of the cost of your covered medications. A deductible is not required for all prescription plans.
- Copay/Coinsurance – This is the cost of each prescription once the deductible has been met. Depending on the type of medication, several drug plans include different “tiers” or amounts of coinsurance or copayments.
| Copay Categories for Part D | |||
|---|---|---|---|
|
Category 1 |
Category 2 |
Category 3 |
Category 4 |
|
Generic |
Preffered |
Non-Preffered |
Specialty |
|
The cheapest medications that your insurance will cover, including all generic medications and a few brand names. |
Known to be the most efficient in their class are branded medications. |
Both preferred speciality pharmaceuticals and non-preferred medications (brand names that are not the "most effective") |
The costliest medications since they are regarded as brand names, specialist items, and not liked |
- Coverage Gap – The term “coverage gap” (sometimes referred to as the “donut hole”) refers to a temporary cap on the amount of medications that the drug plan will cover. Once you and your drug plan have spent a specific amount on covered drugs, the coverage gap will start. These sums all count toward you exiting the coverage gap even though not everyone enters it:
- Annual deductible, copayments, and coinsurance
- The savings you receive on name-brand medications during the coverage gap
- The difference between what you paid for initial coverage and the coverage gap
- You cannot use the following sums to close the coverage gap:
- The cost of your Medicare drug plan
- Cost of drugs not covered by insurance
- What your Plan D pays and what other insurance covers
- Catastrophic Coverage – Once you exit the coverage gap, you automatically acquire catastrophic coverage, which means that for the rest of the year, you just have to make a small coinsurance or copay for covered medications.
- Late Enrollment Charge: If you don’t sign up for a Medicare drug plan when you first become eligible, and you don’t have any other creditable prescription drug coverage or qualify for Extra Help, you may be subject to a Part D late enrollment penalty.
Coverage Under Prescription Drug Plans
To make sure your plan fits your goals and budget, it can be very advantageous to take the time to analyze the various options you have. Different Medicare drug plans will cover different things, and some may have unique guidelines. Review the formulary—the list of medications your plan covers—and guidelines carefully to make sure you are aware of the scope of your coverage and any restrictions.
Your Prescription Drugs Quality
Before making any final judgments, you might wish to consider quality ratings in addition to the costs and scope of coverage. Medicare compiles data from member satisfaction surveys, healthcare providers, and plans to rate the overall performance of the plans.
Ease of Prescription Drug Payment & Pickup
DreamhealthQuotes makes it simple to select a plan based on your preferred pharmacy, but it’s always a good idea to confirm that the location where you often receive your meds is in your plan’s network. Some insurance plans offer mail-order services that allow you to have your medications delivered right to your home, while others charge cheaper copays or coinsurance amounts at specific locations than at others.
Even if you don’t plan to switch plans during AEP, make sure to double-check that your pharmacy is included in your plan’s network for the next year. Plans are subject to change annually.
Explore the Medicare Annual Enrollment Period Guide for 2023
Allow DreamhealthQuotes to compare the Medicare Part D plans available to you.
We can assist you if you’re interested in finding out more about your Medicare Part D prescription drug options. We can quickly assess the choices in your area to make sure you’re receiving all the advantages you’re entitled to. There is no cost to the service, and enrollment is optional.
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