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Medicare Prescription Drug Coverage Guide

Part 5: Choosing a Part D Drug Plan

How to find the one that's right for you

Should I consider a plan that gives coverage in the doughnut hole?

You need to compare plans carefully according to the specific drugs you take to see whether the plans that offer coverage in the doughnut hole are worth the extra premium costs — especially now that you get big discounts in the gap and can buy cheaper generic versions of many of the expensive blockbuster drugs, such as Lipitor and Plavix.

What if I use few or no drugs right now?

A plan with the lowest premium in your area would keep your costs to a minimum while providing coverage you might need later on.  A plan with a zero deductible would cover even very low drug costs immediately.

How can I tell if my local pharmacies are in a plan’s network?

It’s important to choose a Part D plan that has network pharmacies that are convenient to you, because once enrolled you’ll pay more (perhaps even full price) if you buy your drugs from one outside its network. You can find this information before enrolling when comparing plans on Medicare’s Prescription Drug Plan Finder. It also shows which pharmacies are “preferred” by your plan, meaning prices may be lower there. Once enrolled in a plan, you’ll receive a list of the plan’s network and preferred pharmacies.

How can I tell whether a plan will give me good service?

Medicare rates plans on various measures — for example, the quality of their customer service, the accuracy of their drug pricing information and their responsiveness to complaints and appeals — as a result of surveys and consumers’ feedback. Ratings are on a scale of one to five stars, with one star being poor and five stars excellent. You can find these ratings only on the online plan finder on Medicare’s website as explained above.

What if I live in different states during a year?

A Part D plan that has in-network pharmacies nationwide will cover you throughout the United States. If a regional plan offers mail order services, your drugs could be sent to a temporary address in another state — but make sure the plan allows that option.

Should a married couple choose the same plan?

Not necessarily. Each spouse should consider plans separately, according to the drugs she or he takes. There are no price breaks for a couple joining the same plan.

Who can help me make these decisions?

For free, personal help in making decisions about Part D, call your state health insurance assistance program (SHIP).

Patricia Barry writes the AARP Ask Ms. Medicare column and is the author of  Medicare for Dummies (Wiley/AARP, October 2013).

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