Before you talk to any insurance agent, prescription drug plan call center or sign up for a Part D Prescription (PDP) drug plan from a direct mail advertisement go to Medicare.gov and do a plan comparison. The Medicare prescription drug insurance plans are the most complicated and confusing of all the Medicare decisions a beneficiary must make. The Centers for Medicare and Medicaid Services has built one of the best online comparison tools for evaluating PDPs.
Complicated Medicare prescription drug plans
The Part D Prescription drug plans are unnecessarily complicated in their design. Just understanding the deductible, initial coverage period, gap or donut-hole and catastrophic portions of the PDPs can be a daunting task. Add to that complexity a myriad of brand names drugs, generic alternatives, different tiers, prior authorization and that your medications may not be covered by certain plans and you have headache worthy of prescription medication itself.
Medicare drug plan finder is a great tool!
Fortunately, the Medicare.gov plan finder does an excellent job of providing answers to complicated comparative analysis questions between the plans. If there is a downside it is that the comparison can still provide an overwhelming amount of information. Some of the information may or may not be applicable to your situation. Medicare beneficiaries will still have to consider how they like to get the prescriptions, whether they can tolerate generic drug formulations to save money and if selecting a plan with no deductible is worth the higher monthly premiums.
Comparing prescription drug plans and costs
While the following is not a complete “how to” about using the Medicare.gov plan finder for Prescription Drug Plans, I’ve tried to provide a few steps and highlights when comparing plans. The first benefit to the Medicare.gov plan finder is that you can create a drug list and the system will assign you a unique identification number and password date. You can use this saved list to make changes to the drug list and compare new plans that might be offered during open enrollment.
Brand or generic search function
When entering your drugs, you can either type in the generic name or the brand name of the medication. The drug list tool will ask you if you want to use a generic alternative if one is available.
Review your list of saved prescription medications
You can review your drug list once it is complete. Some of the prescriptions you may not use on the regular intervals that are suggested. Keep that in the back of your mind when viewing the total monthly and yearly drug costs. The Medicare plan finder will err on the side of having potential higher drug costs than you might experience. But all things being equal, when you compare plans they will all consider the higher frequency of the medication use. Click on image to enlarge.
Selecting PDPs for comparison
The next step is to compare plans. The Medicare website will first list the plans that include, or nearly include, all of your drugs. This is done on the estimated annual retail drug costs. Consequently, there may be plans with a deductible and those without at the top of the list. While all your prescription medications may be covered, you need to carefully consider if the deductible and any pharmacy restrictions are worth the lower premium of some plans. Click on the image to enlarge.
Drilling down to monthly drug costs
When you have selected the plans you want to compare, click on “View Drug Cost Summary” to see a review of prescription copayments for each drug by plan. This a great break down summary of the different costs of the drugs and what you can expect to pay per plan. The cost of the drugs will vary by plan because –
- The plan may not cover the drug, which means you pay full retail price.
- A specific drug may be on different tier levels (1, 2, 3, 4, 5, or 6) for each plan.
- Some plans will include Coverage Gap pricing that lowers the copayment, but they usually have a higher premium associated with the plan.
Initial, Gap and Catastrophic monthly costs
The overall view will give a detailed month by month analysis of the drug costs and if your prescription drug costs will ultimately put you into the Coverage Gap (Donut Hole) and catastrophic level of drug costs. Also note if any of the plans that have quantity restrictions or prior authorization. Quantity limits may be an issue if you will have extensive travel for several months for which you will need an extra supply when away from home.
Prior authorization and drugs not covered
Prior authorization necessitates the member potentially having their doctor request that the drug be made available to you because there are no other alternatives to treat your medical condition. This can be an unexpected headache or just a minor inconvenience. Pay careful attention to drugs that may not be covered as you will pay the full retail price and it will not add toward your maximum out-of-pocket costs.
What insurance companies won’t tell you
The Medicare prescription drug plan comparison tool is great for narrowing down your list of PDPs to choose from. For those that love an abundance of information, the site provides lots of graphs and different ways to consider the annual drug costs. The Medicare plan finder should be used every year to compare new plans being offered. The insurance companies love members who never shop around especially when their newer plans might include more drugs at lower prices saving you money. But they aren’t going to tell you that. The Medicare plan finder site will help you find your best alternatives each year.