If you’re wondering how to choose a Medicare drug plan that works for you, the following frequently-asked questions may help you make a better-informed decision.
Frequently-Asked Questions about Choosing a Medicare Prescription Drug Plan (PDP)
There are two main ways to get Medicare prescription drug coverage: a “stand-alone” Prescription Drug Plan (PDP) , or an “all-in-one” Medicare Advantage Plan with Prescription Drug coverage (MAPD). You may want to consider an “all-in-one” Medicare Part C Advantage Plan (MAPD) with prescription drug coverage (MAPD). You can get your health care and prescription drug coverage from one plan. However, you will have restrictions on which doctors, hospitals, and other health care providers you can use. MAPD plans provide additional benefits as well, such as dental, vison and hearing, among others.
If you are new to Medicare, generally, your Initial Enrollment Period is the first time to enroll in a Part D Prescription Drug plan (PDP). However, there a 6 key enrollment periods you should know to make the best decision for your unique circumstances. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:
- A Medicare Prescription Drug Plan (Part D)
- A Medicare Advantage Plan (Part C) with prescription drug coverage (also called MAPD)
- Another Medicare health plan type with Medicare prescription drug coverage
- Creditable prescription drug coverage
You won’t pay a late enrollment penalty if you receive Medicare Extra Help to lower your drug costs. Call us today to see if you qualify at 480-834-7447.
If you already have a prescription drug plan, then the Medicare Annual Enrollment Period is the best time to review you plan to see if there is a better fit in a different plan. There may be other circumstance that will give you a special enrollment period, such as:
- You move out of the plan service area, OR
- You enter, leave or live in a nursing home, OR
- Your plan changes and no longer serves your area, OR
- You get Medicare Extra Help to reduce your Medicare prescription drug costs. Call us today to see if you qualify at 480-834-7447.
Each PDP or MAPD plan with drug coverage uses a Medicare-approved drug formulary (a list of prescription drugs covered by a drug plan). It is important to find drug plans that include your prescription drugs on their formulary, and then, compare total cost of the plans.
Roman Brokers in Mesa, AZ will help you compare all of the plans available in your area that meet your individual needs and help you enroll in the plan of your choice during an appropriate enrollment period. Contact Dan at Roman Brokers at 480-834-7447 for more information about picking a plan that best suits your needs.
Medicare drug plans – in both stand-alone PDPs and in all-in-one MAPDs – have a coverage gap (also called the “donut hole”). This is a temporary limit on how much the drug plan covers for the cost of your drugs. The coverage gap begins after you and your drug plan have spent a Medicare-specified amount for covered drugs. Once you and your plan have spent that amount on covered drugs, you enter the coverage gap. This amount is set by Medicare and may change each year.
Most people on lower-tier drugs do not enter the coverage gap. However, if you have any prescriptions for higher-tier medications, you will likely reach the donut hole at some point during the year. Once you reach the coverage gap, you will pay no more than 25% of the cost for your plan’s covered brand-name prescription drugs and 25% of the dispensing fee. For generic drugs you’ll pay 25% of the cost of the drug.
Some Medicare drug plans include additional coverage in the gap. You may get a discount after your plan’s coverage has been applied to the drug’s price. When looking for extra drug cost protection, look for a drug plan that offer “Gap Coverage.” Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap. Call us today to see if you qualify at 480-834-7447.
Roman Brokers in Mesa, AZ will help you compare all of the plans available in your area that include “Gap Coverage” and help you enroll in the plan of your choice during an appropriate enrollment period. Contact Dan at Roman Brokers at 480-834-7447 for more information about picking a plan that best suits your needs.
There is no one-size-fits-all answer, because your costs for prescription drug coverage depends on a number of factors:
- If your medications are a part of your drug plan’s formulary – Look for Medicare plans with drug coverage that includes all of your medications in their formulary.
- The medications you take – Look for Medicare plans with drug coverage that has the largest number of your prescriptions on lower tiers, preferably tiers 1 or 2. Also, look for a plan with “Gap Coverage.”
- The pharmacy you choose – Look for Medicare plans with drug coverage that include your preferred pharmacy as a preferred, or in-network pharmacy. Not all plans include all pharmacies.
- If you qualify for the Medicare Extra Help program to help pay for your drug costs. Call us today to see if you qualify at 480-834-7447.
The best choice of prescription drug coverage for you depends on a combination of all these factors, among others. Finding the best combination for your specific medications will take into consideration the formulary, plan premium, deductible, tier copayments and coinsurance, pharmacy network, gap coverage and more.
Roman Brokers in Mesa, AZ will help you compare all of the plans available in your area that take into consideration all of these factors. Once you make an informed decision, we’ll help you enroll in the plan of your choice during an appropriate enrollment period. Contact Dan at Roman Brokers at 480-834-7447 for more information about picking a plan that best suits your needs.
Yes! Nearly all prescription drug coverage will cost you less out of your pocket if you use generic drugs. Look for drug coverage in a plan with a low monthly premium, no or a low deductible, the largest number of your prescriptions on lower tiers (preferably tiers 1 or 2), and additional savings for 90-day supply or mail order. Also, look for a plan with “Gap Coverage.” Be sure your pharmacy preferences are in-network and have “preferred” status.
Even if you don’t take many medications now, you may still want to have drug coverage in case your health changes. It is important to understand that not enrolling during your initial enrollment period may result in lifetime future penalties. If you want to avoid penalties, look for Medicare drug plans with no or a low deductible, and a low monthly premium. If you need prescription drugs in the future, you can have peace of mind knowing that your plan must cover most drugs used by people with Medicare.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4513642/ reports that over 90% of people with Medicare prescription drug coverage overpay by about 15 percent of expected total out-of-pocket cost each year for drugs and Part D insurance because of suboptimal plan choices, and a significant number make mistakes that cost them more than $1,000 annually.
Consumers spend even more money on Medigap and Medicare Advantage plans. 60% of people with Medicare say they are overwhelmed by the process of choosing a health plan.
My name is Dan Roman
My name is Dan Roman, owner of Roman Brokers Insurance. Located in Mesa, AZ, I am local, and I am a licensed, insured, independent broker. I am certified to represent most major Medicare Advantage, Medicare Supplement and Medicare Prescription Drug Insurance plans in Arizona. I help you compare companies and plans for the best possible combinations of cost, coverage and compatibility for your unique needs. I will walk you through the process and give unbiased and accurate information about your choices. Contact Roman Brokers Insurance today at 480-834-7447. I can provide guidance at no cost and no obligation to you!