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Plan before you choose

Lise-Anne Deoul, Director - Columnist
Posted 10/15/20

Fall Annual Election Period Is Now! From October 15 through December 7, you can make changes as you need to your Medicare coverage. Any changes you make will take effect January 2021. If you choose …

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Plan before you choose

Posted

Fall Annual Election Period Is Now! From October 15 through December 7, you can make changes as you need to your Medicare coverage. Any changes you make will take effect January 2021. If you choose to stay with your current coverage, nothing will change.

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone prescription drug plan (PDP), for those enrolled in Original Medicare, or a set of benefits included with your Medicare Advantage Plan.

You should make sure to find a Part D plan that meets your specific health care needs. Before you start looking at plans, gather a list of the prescriptions you take, including their dosages and usual costs, and the pharmacies you regularly use.

Here are some questions you should ask before choosing a Part D plan:

Drug coverage

Are my prescriptions on the plan's formulary?

The formulary is the list of prescription drugs for which a Part D plan will help pay.

Does the plan impose any coverage restrictions, such as prior authorization, step therapy, or quantity limits?

Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug.

Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one.

Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.

If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)

Costs

How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need?

How much will I pay for monthly premiums and the annual deductible?

How much will I have to pay for brand-name drugs? How much for generic drugs?

What will I pay for my drugs during the coverage gap?

If a drug I take has a high coinsurance, is there a drug I can take that will cost less? (Ask your doctor.)

Am I eligible for Extra Help or a State Pharmaceutical Assistance Program (SPAP) like EPIC?

Pharmacy network

What is the service area for the plan?

Can I fill my prescriptions at the pharmacies I use regularly?

Can I fill my prescriptions when I travel?

What will my coverage options and costs be if I visit out-of-network pharmacies?

Can I get prescriptions by mail order?

Coordination with other insurance

Will Part D work with other coverage I have to lower my costs?

Do I need to enroll in Part D if I have other creditable coverage?

Do I need to enroll in Part D if I have job-based drug coverage?

There is no one best Part D plan for everyone. Instead, you should ask questions and make sure to find a Part D plan that meets your specific health care needs.

Check back next week for information on Medicare Advantage Plans and what you need to know during this Medicare Annual Election Period.

Feel free to call the Office for the Aging with any questions at (845) 807-0241.

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