Do’s and Don’ts for Medicare Part D

Family Health, Featured Article, Healthy Living
on October 13, 2014
medicare dos and donts

With Medicare Part D Annual Open Enrollment season around the corner, it’s important for those who qualify to start thinking about their Medicare coverage for 2015. Admittedly, however, confusion still abounds. And the process of navigating the complex world of Medicare can be daunting indeed. Even for those who are loathe to publicize that they have reached the age of sixty five—going so far as to shun Senior Citizen metro cards and movie discounts for fear of anybody knowing your real age—the potential savings and benefits from enrollment far outweigh the intangible costs of whispering to your pharmacist that the medication’s price is covered by Medicare. Part D can also assist those who are retired and are losing their employer-provided prescription coverage. And even if they are not eligible themselves, young professionals might be asked to help a family member pick a Medicare plan; so it’s essential to better understand how to choose the right one.

Unfortunately, it’s certainly easy to go awry. For instance, you might assume that a low premium (the monthly amount you pay for the plan) equals a “good deal.” And while it may seem painless to compare premiums, there is actually much more to consider. But before we get into how to select a plan, let’s talk about what exactly Medicare Part D entails.

“Medicare Part D is the part of Medicare that covers prescription medications. Medicare prescription drug plans are operated by private companies approved by Medicare, and these plans make prescription medications safer and more affordable for Medicare beneficiaries,” explains Dr. Rebecca Rabbit, Pharm D, vice president, Medicare solutions at Express Scripts.

How do you know if you need a Medicare Part D plan?

Dr. Rabbit continues, “If you are eligible for Medicare and take any prescription medications on a short- or long-term basis, then you should enroll in a Medicare Part D Plan. Even if you are not taking any medications, you should consider enrolling because if you don’t, when you first become Medicare-eligible, you will have to pay a penalty when you do.

Plans with a high deductible, large copayments and/or a high coinsurance requirement (the portion of the price you must pay for your medications) may have lower monthly premiums but could cost significantly more if you encounter unexpected or high medication costs. Meanwhile, Part D Plans that have a higher monthly premium may offer money-saving options over the long term.”

Knowing what to look for can make the task of selecting a plan a lot easier. Here are the most important elements on which to focus, according to Dr. Rabbit…

  • Premium: That’s what you pay for the insurance each month. But it is only the starting point, even though for all too many it is also the ending point!
  • Deductible: This is the amount you are required to spend in total each year on your medications before your plan’s coverage kicks in. After the premium, it is also still just an easy focal point that may disguise the full cost or benefit of a Plan. It is important to remember that this is a 100% number, meaning it eliminates coverage completely, until the deductible level is reached; unlike the copay/coinsurance amount which is an ongoing percentage of each purchase.
  • Copayments and Coinsurance: The answer to the dreaded question, “How much is my copay?” is the portion of every post-deductible charge that you are required to pay outside of the coverage. The answer you want to hear is always “There isn’t one.”
  • Formulary: This is the list of medications covered by the Part D Plan. Not all plans use the same formulary or drug list, so your top priority should be to find a plan that covers the medications, or clinically appropriate alternatives, you currently need to take.
  • Home delivery: If you take a medication on a long-term basis, check to see if you can receive your medications on a regularly scheduled basis in the mail. With home delivery, you can usually get a 3-month supply of a medication for a lower co-pay. Some plans even offer to ship for free, since it costs them less to process in bulk rather in individual dosages through a local pharmacy.
  • Pharmacy networks with lower-cost options: Some plans offer lower co-pays when you use certain pharmacies. This is known as a Preferred Pharmacy Network. Plans that have a national pharmacy network also make a lot of sense if you travel or spend time away seasonally.
  • Pharmacist Support: Some Part D Plans will provide you with access to their own pharmacists or Specialty Pharmacists to advise you. Pharmacists are a great resource for helping you find cost-effective alternatives for your prescription medication needs, and can help you overcome any barriers to not taking your medications as prescribed. Taking your medications the right way can keep you healthy and help prevent additional healthcare costs, such as hospital or emergency room (ER) visits.
  • Customer service: Look for a plan with knowledgeable Medicare (as distinct from medication) advisers who will help you understand your plan and make sure you get the most value.

Beyond these plan offerings, you also want to make sure that you’re getting the advice and care you need from your plan. While you are researching your options, call each plan and ask questions about their coverage. Not only will you get the answers you need to make a smart decision, but you will also get a feel for how well the plan will treat you.

Lastly, looking at the plan’s star ratings can help take the guesswork out of choosing a high-quality plan and can give you peace of mind with your decisions. Medicare determines a plan’s Star Rating each year, providing consumers with a current and unbiased measurement of a plan’s performance. Look for a plan with 3 or more stars.

“Don’t procrastinate!” concludes Dr. Rabbit. “Plan details are available on Oct. 1. Start comparing plans right away so you have the time you need to make a smart decision.” And do your research: “Even if you currently have a Part D Plan, it’s important to review the 2015 plan details to make sure it’s still the best choice. Costs and coverage can change from year to year, and so can your medication needs. Also, contacting plans to talk with an advisor can be extremely valuable as you make your decision.”

Finally, don’t procrastinate—enroll early! The annual enrollment period—when you can actually sign up for a plan—begins October 15, 2014 and ends December 7, 2014. If you delay, you could face a penalty.

For more information visit