En español | Your goal in choosing a Part D plan is to select a plan that 1) covers all your drugs with the lowest out-of-pocket cost, 2) provides good service and 3) checks the box on any other personal requirements you might have.
The average Medicare beneficiary has 23 stand-alone Part D plans to choose from in 2022. Comparing that many plans can be overwhelming, but several tools and resources can make assessing plans in your area easier.
Here’s how to determine your best Part D plan when you first sign up or during Medicare’s annual open enrollment period of Oct. 15 to Dec. 7 for new coverage starting Jan. 1. Part D plans can change their costs and coverage every year, and prescription drugs you take can change, so it’s a good idea to assess your options every year.
Don’t look just at a plan’s premiums. Also compare the coverage and total costs for your medications. Your answers to these questions will narrow the field.
Using Medicare’s Plan Finder, make sure the drugs you take are part of a plan’s formulary (its list of covered drugs). Otherwise, you’ll pay full price for drugs that a plan doesn’t cover.
After you’ve entered all of your medications, you can see how much you would have to pay for them with each plan. Two plans that cover your medicines may have very different costs, depending on the copayments they charge for your drugs.
To find potential costs in the Plan Finder, type in your zip code, drugs and dosages. Then click on View drugs & their costs for each plan to see how much you would pay for your medications under each plan available in your area.
Most Part D plans have four or five pricing tiers, with the lowest copayments for preferred generic medications, followed by generics not on the preferred list, preferred brand-name drugs, other brand-name drugs, and sometimes a separate high-priced tier for specialty medications. That’s not how you’ll see the information presented in Medicare’s Plan Finder, but it can help you understand why you might see different prices for the same prescription as you look at all the plans in your area.
Going to the website of a plan you’re interested in may allow you to find out more about how the plan regulates your medicines. You’ll want to know whether a plan imposes any restrictions, such as requiring your doctor to complete prior authorization forms before a drug will be covered, or using a lower-cost drug first before the plan will cover a similar but more expensive medication. That’s known as step therapy.
Another option: Call 800-MEDICARE (800-633-4227) for help. Or work with representatives from your State Health Insurance Assistance Program (SHIP).
This can be just as important in determining the price you pay for your prescriptions as the plan’s formulary. Many Part D plans have preferred pharmacies that charge lower copayments than other pharmacies in the plan’s network.
You can enter up to five pharmacies in the Plan Finder to determine whether your pharmacies are preferred in-network pharmacies, standard in-network pharmacies that have higher copayments, or not in a plan’s network. The Plan Finder shows what your out-of-pocket costs would be for your medications at the different pharmacies.
One example: If you use an in-network pharmacy, the least expensive Part D plan in one area charges $7 for a 30-day supply of 5 milligrams of amlodipine, the generic equivalent of blood pressure medication Norvasc. The same monthly prescription is $356.37 at a nearby out-of-network pharmacy.
Several factors can affect the total cost for a Part D plan during the year, including premiums, deductible and copayments for your medications. Plans are allowed to charge a deductible of up to $480 in 2022, but some have no deductible.
Premiums can vary significantly, but a plan with low premiums may cost you more if it has high copayments for your drugs. When you’re in the Plan Finder, you can sort the plans by Lowest drug + premium cost to find out which plan’s total costs will be least expensive for you for the year.
The Plan Finder also shows your estimated total monthly drug costs for each plan. That can be helpful if you’re looking for a plan that spreads expenses throughout the year rather than charging the biggest bills in the first few months.
Part D has no coverage caps, but after you spend $7,050 out of your pocket in 2022, you reach Medicare’s catastrophic coverage level. After that, you pay 5 percent or less of your drugs’ retail costs.
The Plan Finder can show you plans’ star ratings, which the Centers for Medicare & Medicaid Services award to Part D and Medicare Advantage plans based on several quality measures. For Part D plans, the categories include accuracy of pricing, complaints, customer service and members’ experiences.
Five stars is the highest rating, one star is the lowest. Part D plans receive star ratings based on up to 12 measures as well as an overall star rating.
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