Compare Plans During Open Enrollment to Save Money
Our Certified Pharmacy Technician Becki Tinder shares ways to simplify the process of comparing Medicare Part D (prescription benefits) plans.
Best Prescription Coverage at the Best Price
Medicare Part D open enrollment runs from October 15 through December 7 each year. If you’re eligible for Medicare Part D, now's the time to review your options and see which plan best meets your needs for the coming year. Plans change their costs and covered prescriptions each year, so it’s important to compare plans even if your current plan is working for you.
Being informed and choosing the right plan for your needs can save you money. Although it’s unlikely you'll find a plan that covers 100%, the idea is to minimize your expenses while getting the best coverage. We provide resources at the end of this post to help make this process simpler.
Questions You Should Ask
Here are some questions to consider as you compare plans for 2020.
1. How well does this plan cover the medications I need?
It’s best to have a list of your current and anticipated medications. For instance, if you have cancer, research possible oral chemotherapy drugs for your type of cancer and check to see if they’ll be covered (note that some oral chemotherapy drugs are covered by Medicare Part B, not Part D). You don’t want to be stuck with a plan that isn’t going to cover the drugs that you need.
2. What is the plan’s star rating?
Plans are rated with stars based on quality of care, and 5 stars is the best. If your plan fails to provide you with the best care, you may be able to switch to a 5-star plan without penalty once during the year. You can find plans’ star ratings at the Medicare website.
3. Will my cost be affordable?
Each plan has a monthly premium and may have a yearly deductible. The copay (flat fee) or coinsurance (a percentage of the cost) for your prescription drugs may vary from plan to plan. Once you have a list of the medications you’ll need along with dose and frequency, you can determine what your potential out-of-pocket expenses will be for each plan and which plans are comfortably affordable. You may also qualify for Extra Help through Medicare based on need.
4. Does this plan offer convenience for filling my prescriptions?
Each company that offers a Medicare drug plan has a list of pharmacies you can use. You should check to see if your preferred pharmacy is on a plan’s list. Some plans have “preferred” pharmacies which offer lower costs than other in-network pharmacies. If you use an out-of-network pharmacy, you’ll likely pay a higher copay or coinsurance. Plans can’t make you use a mail-order pharmacy, but you may save money if you choose this option.
5. How are specialty drugs handled?
Some plans may require you to use specialty pharmacies for specialty medications, such as oral chemotherapy. Your copay or coinsurance may differ for specialty drugs as well. This differs with each plan.
6. Will my plan cover expensive meds for specific health conditions?
All insurance plans have what’s called a formulary, a predetermined list of medications they prefer to cover. If your medication is not on this list, it may still be covered if you have prior authorization, or it may be covered, but with a higher copay.
Help with Medicare Part D
We advise making an appointment with the local SHIIP (Senior Health Insurance Information Program) office to meet with a volunteer who will help you compare plans and find the best option for you based on your unique situation. SHIIP can help you:
Understand the Part D benefit
Compare Part D plans
Assist with Part D plan enrollment process
Apply for Extra Help with Medicare drug costs
Know when you can enroll in, drop and change plans
Advocate when you have problems with a plan
Additionally, this guide, prepared by the Iowa SHIIP office, provides extensive information about Medicare Part D and Open Enrollment.
While we strongly recommend meeting with SHIIP, you can also compare plans and enroll at the Medicare website.
I’m also available (by appointment) to help answer questions and get you lined up with resources to make this process less intimidating than it seems. At The Ghosh Center, we’re dedicated to making your healthcare affordable and finding resources to help reduce your expenses. In fact, we have surpassed the nine-million-dollar mark in total assistance secured for our patients. Much of this goes toward prescription medication.
SHIIP Resources
Heritage Area Agency on Aging (SHIIP): 319-398-5559
Mercy SHIIP office: 319-861-7887
Unity Point SHIIP office: 319-369-7475