Choosing The Right Medicare Drug Plan

By Marv Law, CLTC

There is never a single company or drug plan that is right for everyone.  Even couples in the same household can often find it more appropriate to choose different plans, even with different companies because of their different medications.   The following tips may help you avoid common mistakes when selecting a drug plan.

  1. Check the Plan’s drug formulary for your medicationsSince all Medicare Part D Drug Plans have similar features, a frequent error when shopping is to only look at the deductibles and co-payments on each Tier level.  However the benefit pages alone do not necessarily provide an accurate indication of what your costs will be through the year.  For example, even though you may take a particular generic drug, the formulary drug list for a plan may place that drug on a Brand Name Tier rather than on a Generic Tier, or worse yet, not even include it at all in their approved formulary drug list, causing you to pay for the entire cost of the drug.
  2. Know how your drugs are covered in the Coverage GapAll Part D Drug Plans have a gap (donut hole) in coverage after the cost of purchased drugs reach a particular accumulated amount for the year.   If you anticipate reaching the donut hole, check to see how your drugs are covered at that time.  While all plans have discounts during the gap, some plans also include coverage for some drugs in the gap, which can reduce your out of pocket expense.  Also helpful to know is that the insurance companies negotiate the cost of drugs with the participating pharmacies, which can affect the timing each year when a person enters the Coverage Gap on their drug plan.  So not only is it useful to know how your drugs are covered in the Gap, but also when you will enter the gap on a plan can be beneficial when planning your budget.
  3. Learn how the Plan works at your pharmacyPlans often have different costs for drugs at participating and non-participating pharmacies.   Some plans even have different costs for participating pharmacies, for “preferred participating” and “standard participating pharmacies.”  Since the cost of your drug can vary based on the pharmacy you use, it is helpful to know the level of participation of your pharmacy, and if it might be appropriate to either change your drug plan or change your pharmacy.

There are a number of resources to research answers to these questions when considering a drug plan, including  However if you prefer visiting someone in person, a local licensed professional who is Certified with several Medicare Advantage and Drug Plans is typically able to provide objective advice and recommendations based on your specific needs and concerns.  These professional services can assist you in your research and are never any cost to you.