UPDATED Jan. 12, 2019. Here are several questions you should ask when learning how to choose Medicare Part D.
How to Choose Medicare Part D – Costs
- What is the yearly deductible?
- What is the monthly premium?
- What is the copayment/coinsurance?
– Is it the same for any prescription, or is it tier-dependent?
– Are there increases when your drug costs reach a certain limit?
- Coverage Gap
– Is there any gap coverage?
– How are generic drugs treated?
– Is there an extra premium option to reduce the impact of the coverage gap?
Medicare Prescription Drug Plan Coverage
- Are all your prescriptions covered by the plan formulary (formulary is a list of drugs covered by the PDP; it includes both generic medicines and brand-names)? You are entirely responsible for the cost of prescriptions that are not a part of the formulary.
- Does the plan include prior authorization, when a doctor must contact the plan administrator to show the medical necessity of the drug?
- Are there quantity limits to how much medication you can get at one time?
- Are you required to try a lower cost drug before the plan covers a prescribed, more expensive medication?
How to Choose Medicare Part D – Convenience
- Is your local pharmacy a ‘network pharmacy’ that participates in the plan? Different pharmacies can charge different prices for the same drug. If your pharmacy isn’t in the plan’s network, you must pay the full price for the drug with no insurance coverage.
- Does your plan include a mail-order program?
- What premium payment options your plan offer?
Medicare Prescription Drug Plan and its Overall Star Rating
US Government Sources
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