When it comes to choosing your Medicare plans, research is extremely important. The amount of information Medicare provides to make this easier is both a blessing and a curse, though. Sometimes, it feels as though it would be easier if someone just said, “Get this plan, it has everything you need.”
You need to evaluate the plans, and that means looking at the formularies versus your own needs (and what you suspect may happen in the future). Cost, of course, is also an issue. Luckily, Medicare provides all of this information, as well as a ratings system to help guide your choice.
If you need help deciding on a plan and enrolling, Medicare Solutions Licensed Agents are well-versed in plan data and coverage types. Contact us to learn more.
Do You Need Plan D?
Those with original Medicare (Parts A and B) do not have prescription drug coverage. In addition, some Medicare Advantage (Part C) plans do not include drug coverage, and certain other plan types may not either. If any of these situations ring true for you, Medicare Part D is the answer.
If you had Part D in 2016, you need to review your options. Plans typically go through changes each year, such as drug formulary changes, and some Part D plans will not be available in 2017.
Evaluate Your Part D Plan
Choosing the right Part D plan is much more than finding the lowest premium. While you want a premium you can afford, if the plan covers very few of your prescriptions, even a rock-bottom premium is too expensive.
You need to look at the plan’s drug formulary to see which prescriptions the plan covers. Look for your prescriptions on the formulary. If it lists your prescriptions, the next question is on which tier, as each tier has a different co-pay.
Look at the pharmacies as well. In fact, you may want to choose the pharmacy first when comparing plans, as pricing often varies by pharmacy. If you have a favorite pharmacy, look at its pricing, but be open to making a change if you find one with lower rates.
Looking at Your Prescriptions
Gather all prescriptions you take before comparing plans and formularies. In addition to checking whether the formulary covers a certain drug, look at any restrictions placed by the insurer. Some require your healthcare provider to obtain authorization from the insurer before covering the prescription. You may also find a “step” requirement, meaning that the plan requires you to try a generic or cheaper version of the prescription before covering the version you currently take.
Remember, plans change every year, so you need to check the formulary every open enrollment period. Just because your plan covers your prescriptions now, that does not mean it will cover them next year.
Review Your Out-of-pocket Costs
The temptation to choose the plan with the lowest premium can be strong. However, your out-of-pocket costs do not begin and end with the premium.
Potential out-of-pocket costs include the premium, co-pays, co-insurance, and deductibles. This is why a plan with a higher premium may actually cost less. Look at your total spend from 2016 to help determine the real plan cost.
Check the Ratings
Every October, Medicare releases ratings on Part D plans, called the Medicare Star Rating System. Plans receive an overall rating (up to five stars), as well as ratings on four subcategories. These are:
- Customer service
- Member experience
- Member satisfaction, including complaints, issues experienced receiving service, and how many members choose to leave the plan
- Pricing and safety
If you have trouble deciding between two plans, a look at each plan’s ratings helps tip the scales in favor of one or the other.