Use Medicare.gov to find plans: Start your search by using the Medicare Plan Finder on Medicare.gov. This tool allows you to compare available plans in your area based on the medications you take. It’s a helpful way to view the various options side by side, including coverage, costs and the pharmacies that work with each plan.
Look for restrictions: Some Medicare Part D plans have restrictions, such as prior authorization, quantity limits or step therapy, which may affect how and when you can access certain medications. Review these restrictions before choosing a plan to ensure your medications are easily accessible without delays.
Understand the exception process: If your medication isn’t covered by your chosen plan, you may be able to request an exception. It’s important to understand how the exception process works and how to navigate it if necessary. Plans are required to provide coverage for necessary medications under certain circumstances, so knowing your rights can help avoid gaps in coverage.
Compare monthly premiums: Monthly premiums can vary significantly. Rather than simply seeking lower premiums, balance the cost against the coverage offered. A plan with a low premium might not cover your specific medications or could have higher out-of-pocket costs in other areas.
Compare annual deductibles: Some Medicare Part D plans have an annual deductible, which is the amount you pay out-of-pocket for your prescriptions before your plan begins to cover costs. Compare deductibles across different plans to see which one fits your budget.
Estimate out-of-pocket costs: Consider how much you might pay out of pocket, including copays and coinsurance for your medications. The Medicare Plan Finder tool can help by providing estimates based on specific drugs you take and pharmacies you use.
Seek help when necessary: If you’re struggling to choose a Medicare Part D plan, consider seeking help from a Medicare counselor, financial advisor or insurance agent. These professionals can offer personalized advice based on your health and financial needs, making the decision-making process smoother and less stressful.