How to Select the Right Medicare Prescription Drug Plan for You

If you’re on Medicare and take prescription drugs, this won’t surprise you: The costs of medications are rising fast. Up an estimated 12.6 percent in 2014, prescription drug costs are projected to rise by an average of 7.3 percent annually, according to U.S. Department of Health and Human Services.

But that doesn’t mean you have to bear the brunt of these increases. With the right planning and strategy, you may be able to lower your Medicare drug costs—or at least prepare for rising costs. It starts with choosing the right prescription plan for you.

It’s important to know that insurance companies can revise their formularies throughout the year and Medicare Part D drug lists are updated on an annual basis. This means that your prescription benefits—your premiums, deductibles, copayments and list of accepted medications—can change throughout the year or drastically from one year to the next. This is why it’s important to keep current with your prescription benefits. Follow these tips to help you select drug benefits before committing to a plan during open enrollment:

Make a list of the medications you expect to take over the next year. 

Research your options. Review Medicare Advantage plans and/or insurance plans with a Medicare Part D drug plan and select three to compare. To help gather information and narrow your choices, you can:
  • Check the Center for Medicare and Medicaid Services (CMS) website to compare plans and drug formularies.
  • Call your State Health Insurance Assistance Program and speaking to a representative. To get the telephone number and web address for your state, click here.                      
  • Talk to your pharmacist. Many pharmacists are knowledgeable about different drug plans.
  • Compare total annual drug costs. One of the best ways to evaluate a Medicare Part D drug list is by costs, i.e., premiums, deductibles and out-of-pocket expenses. If you have a Medicare Advantage plan, you may skip this step, as drug costs are folded into the plan.
Check the formulary. This is simply a list of covered medications. Once you found a plan that you like (even if it’s your current plan), make sure your medications are covered and the copayments are clearly defined. It’s common for plans to remove previously covered medications and change drug cost tiers on a yearly basis. Brand-name medications usually go through formulary changes more often than generic drugs; and costs for expensive drugs can vary greatly from plan to plan.

Find out all of your costs. Before committing to a plan, make sure you understand all of the inner workings of the plan. For instance, many drug plans charge coinsurance for brand-name and specialty drugs. You also may be charged different amounts based on the pharmacy you use.

Ask yourself if this plan will work for you. Do you like the pharmacies that are contracted? Does it offer a mail-order program?

Be open to selecting different plans for you and your partner.  A plan that may work for you may not be the best choice for your significant other.

Make a decision regarding the type of plan you want before contacting an insurance agent. Knowing what type of plan you want will enable your insurance agent to quickly narrow down the best options for you.   

Sign up for Medicare before you turn 65. Medicare adds a one percent of the national base beneficiary premium, which was $34.10 in 2016, onto your monthly premium for every month your Medicare registration is delayed. To avoid penalties, you can register for Medicare three months before you turn 65.

Visit Medicare Pharmaceutical Assistance Program
to find manufacturer discounts on medications.

Finally, talk to your MDVIP physician. They will work with you to determine the best medications for you and may be able to help you lower prescription drug costs.
13 Comments
Paulette
Dec 1st, 2016
How much is the annual fee that covers the comprehensive wellness program?
Yvonne
Oct 29th, 2016
Can anyone answer this question. We are currently under medicare with a supplement by my husband's former employer (we are retired) So his insurance is paid for including drugs dental etc. The problem, this year they are changing to a Medicare Advantage Plan which is fine for him, but if he is deceased prior to me, they would not keep me under the plan- so it is my understanding that at that time if I went back to medicare as primary I would be penalized for not having stayed with them.
1 Reply
MDVIP
Oct 31st, 2016
Greetings Yvonne.

This is a complicated question that requires the expertise of an insurance agent. You can also call the Medicare Hotline at 1800-MEDICARE (1-800-633-4227).

In good health,
MDVIP

Bonnie Kounas
Sep 22nd, 2016
Have you heard of GoodRX. Have saved me on scrips several times. Why not let members know about them.
Donald Lewis
Sep 22nd, 2016
Keep communication coming keep try to make your program great. Good work ! Don
1 Reply
MDVIP
Sep 23rd, 2016
Greetings Don.

Thank you for the kind words. It’s appreciated.

In good health,
MDVIP
Eppa Hunton
Sep 22nd, 2016
With the fees my wife and I are paying, it would be helpful if MDVIP could help rather than say in 1000 words, do it yourself.Maybe some tools, like a way to accumulate the data of drug lists that might be used or a list of drug plans with their deductables and co=pays to compare plans.
Also, what can be done about mid year changes that affect my costs?
Barbara Wilson
Sep 21st, 2016
Thank you for your advice. My advice to you is to have someone proofread your message. These mistakes do not speak well for the message you are sending. Sloppy! E.g. second paragraph "bear to brunt" should be "bear the brunt" and under "Check the Formulary" - "This is simple a list" probably should be "This is simply a list". There may be other mistakes but I didn't want to waste my time reading more closely. Thank you.
Joyce DeYoung
Sep 21st, 2016
I have tried to send in a comment to correct an error in your discussion of the late enrollment penalty, but the system won't accept it, saying that it "contains content that is not allowed." Since it contains nothing that you can't find on the Medicare.gov website, I'm at a loss. Where can I find the rules for your blog contents?
1 Reply
MDVIP
Sep 22nd, 2016
Greetings Joyce.

You were able to submit your blog comments. Thank you for pointing out the typo in the dollar amount; it has since been changed.

In good health,
MDVIP

George Middleton
Sep 21st, 2016
CHRIS PAPADOPULO is correct, the link to the CMS website is incorrect. Update the link to ....questions/home.aspx (not home/aspx).
William e Smith Pharm D PhD
Sep 21st, 2016
Your comment that the more expensive the plan the more the pharmacy makes. Not correct.
The PBMs or PDPs is where the big money is being made. often times, the local pharmacist is dispensing the medications at a loss. Be careful when you are digging into pharmacy and pharmaceuticals financials.
1 Reply
MDVIP
Sep 22nd, 2016
Greetings Dr. Smith.

Because the information available regarding this issue varies so much, we’ll edit the blog to reflect your suggestion.

In good health,
MDVIP

David Smith
Sep 20th, 2016
Chris, try this:

https://www.medicare.gov/find-a-plan/questions/home.aspx
1 Reply
MDVIP
Sep 21st, 2016
Greetings David.

Thank you very much for your assistance.

In good health,
MDVIP

Sharon
Sep 20th, 2016
I am not meficare eligible... Have many years to go before I am.

On private Insurance
Chris Papadopulo
Sep 20th, 2016
I clicked on your link to Medicare and it did nit work
1 Reply
MDVIP
Sep 21st, 2016
Greetings Chris and George.

We’re not sure why the link is not working for you. An easy solution is to cut and paste the link into an address bar.

In good health,
MDVIP

Kathy Kingsley
Sep 20th, 2016
Do I have to have Medicare? We r covered by my husband's insurance
1 Reply
MDVIP
Sep 20th, 2016
Greetings, Kathy.

MDVIP recommends that you speak with your physician to determine which insurance plans he/she accepts. Please note that the social security administration recommends that you sign up for Medicare three months before reaching age 65, even if you are not ready to start receiving retirement benefits. You can sign up for Medicare Part A (Hospital Insurance) and Part B (Medical Insurance). Because you must pay a premium for Part B coverage, you are able to turn it down. For more information, please visit https://www.ssa.gov/medicare/

In good health,
MDVIP
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