Comparing Part D Plans – A Step-by-Step Guide to Using Medicare.gov

This article is re-posted (with revised dates and updated information) from a previous blog post in 2013.

Comparing Part D plans is an essential task for those on Medicare. Part D is the part of Medicare that covers prescription medications, and frankly, is often the most confusing and complex part of Medicare. It can also be the most expensive, particularly if you have chosen the “wrong” Part D plan.

Part D has an annual enrollment period (contrary to Medicare Supplement plans, which do not). This year, the Part D annual enrollment period, or AEP, runs from October 15 through December 7. Any changes made to your coverage during this time period will take effect on 1/1/16.

So, why do you have to compare plans each year? Can you not just choose a plan and stay with it? Yes, you certainly can stick with the plan that you have now. If you take no action during AEP, your plan will carry you into the next year (as long as it is not being discontinued). But, this is not always a wise strategy. Many things about the plans change from year to year.

Each year, insurance companies have to have their plan outlines/designs approved by the Centers for Medicare and Medicaid Services (CMS). Medicare/CMS sets forth minimum guidelines that they must maintain, but they can expand on those as they see fit. Typically, premiums, deductibles and co-pays on each plan change each year. Also, there is the variable of your actual medications, which may have changed and may make a different plan a better option.

So, how to do you compare the Part D plans. Fortunately, Medicare has put all of the plan information on their website (2016 information will be available around 10/1/15). However, the site is not always very user-friendly. Here are the steps to follow to compare the Part D plans:

  1. Point your web browser to http://medicare.gov.
  2. Click the green button named “Find health and drug plans” (mid-way down, left hand side).
  3. Enter your zip code and click “Find plans”. You may be prompted to enter your county (if your zip code spans multiple counties) – if so, select your county and click “Continue”.
  4. Answer the next two questions and click “Continue”.
  5. This will take you to the drug entry screen. You should enter your medication names exactly as they are listed on the label (in other words, don’t list the brand name if you take a generic equivalent). Then, select the dosage and frequency when prompted. Once you have entered them all, select “My Drug List is Complete” (below the drug names).
  6. Next, select your preferred pharmacy. This is important as co-pays etc can vary on some plans from one pharmacy to the next. Choose the pharmacy that you use now or would most likely use and click “Add Pharmacy” below the pharmacy name. Then, click “Continue to plan results” at the bottom of the screen.
  7. Under “Summary of search results”, select ONLY the checkbox beside “Prescription Drug Plans”. Then, click “Continue to plan results”.
  8. This brings up all the plans for your area and the results are sorted by “lowest estimated annual retail drug costs”. In other words, the plans are listed in order of which plan would cost the least to you over the course of an entire year, taking into account premiums, deductibles, and co-pays for your specific medications (that you entered).

This is truly the best way to compare Part D plans. You can even sign up for the plan you want right there on the Medicare website, or you can get information about contacting to company to enroll. It is a little cumbersome and time-consuming, but the savings that can result are significant. Each year for the last 10 years, I have had a client save $2000+ on Part D costs simply by changing plans to one that fits their medication profile better.

We perform the Part D comparisons at no cost for our Medicare clients, as most independent agencies do (or should do). If you want more information or have questions, please contact me online or call us at 877.506.3378.

Comparing Part D Plans – Step by Step Guide to Medicare.gov

comparing part d plansComparing Part D plans is an essential task for those on Medicare. Part D is the part of Medicare that covers prescription medications, and frankly, is often the most confusing and complex part of Medicare. It can also be the most expensive, particularly if you have chosen the “wrong” Part D plan.

Part D has an annual enrollment period (contrary to Medicare Supplement plans, which do not). This year, the Part D annual enrollment period, or AEP, runs from October 15 through December 7. Any changes made to your coverage during this time period will take effect on 1/1/14.

So, why do you have to compare plans each year? Can you not just choose a plan and stay with it? Yes, you certainly can stick with the plan that you have now. If you take no action during AEP, your plan will carry you into the next year (as long as it is not being discontinued). But, this is not always a wise strategy. Many things about the plans change from year to year.

Each year, insurance companies have to have their plan outlines/designs approved by the Centers for Medicare and Medicaid Services (CMS). Medicare/CMS sets forth minimum guidelines that they must maintain, but they can expand on those as they see fit. Typically, premiums, deductibles and co-pays on each plan change each year. Also, there is the variable of your actual medications, which may have changed and may make a different plan a better option.

So, how to do you compare the Part D plans. Fortunately, Medicare has put all of the plan information on their website (2014 information will be available around 10/1/13). However, the site is not always very user-friendly. Here are the steps to follow to compare the Part D plans:

  1. Point your web browser to http://medicare.gov.
  2. Click the yellow button named “Find health and drug plans” (mid-way down, left hand side).
  3. Enter your zip code and click “Find plans”. You may be prompted to enter your county (if your zip code spans multiple counties) – if so, select your county and click “Continue”.
  4. Answer the next two questions and click “Continue”.
  5. This will take you to the drug entry screen. You should enter your medication names exactly as they are listed on the label (in other words, don’t list the brand name if you take a generic equivalent). Then, select the dosage and frequency when prompted. Once you have entered them all, select “My Drug List is Complete” (below the drug names).
  6. Next, select your preferred pharmacy. This is important as co-pays etc can vary on some plans from one pharmacy to the next. Choose the pharmacy that you use now or would most likely use and click “Add Pharmacy” below the pharmacy name. Then, click “Continue to plan results” at the bottom of the screen.
  7. Under “Summary of search results”, select ONLY the checkbox beside “Prescription Drug Plans”. Then, click “Continue to plan results”.
  8. This brings up all the plans for your area and the results are sorted by “lowest estimated annual retail drug costs”. In other words, the plans are listed in order of which plan would cost the least to you over the course of an entire year, taking into account premiums, deductibles, and co-pays for your specific medications (that you entered).

This is truly the best way to compare Part D plans. You can even sign up for the plan you want right there on the Medicare website, or you can get information about contacting to company to enroll. It is a little cumbersome and time-consuming, but the savings that can result are significant. Each year for the last 7 years, I have had a client save $2000+ on Part D costs simply by changing plans to one that fits their medication profile better.

We perform the Part D comparisons at no cost for our Medicare clients, as most independent agencies do (or should do). If you want more information or have questions, please contact me online or call us at 877.506.3378.

How to Compare Medicare Part D Plans

Medicare Supplements (Medigap) plans are relatively straight-forward. The plans fill in the “gaps” in Medicare. They are Federally-standardized, so every company provides the same coverage plans. They do not have networks, so you can go to any doctor or hospital that accepts Medicare. Claims are automated through the Medicare “crossover” system, so all of the plans are the same in that regard. Put simply, navigating Medicare Supplement plans and choosing a plan is much less painstaking that many people make it out to be.

All that said, the same cannot be said regarding Medicare Part D Rx plans. Medicare Part D is very complex – there are approximately 30-40 plans offered in each county. The plans vary in: premium, deductible, tier structures, pharmacy networks, co-pays, prior authorization requirements and other areas. Choosing a Part D plan can be extremely difficult and time-consuming.There are a few steps, however, that you can follow to make sure that the plan you choose is the right one for you.

First of all, we would always recommend choosing a plan based on your current medication needs. Obviously, your needs may, and probably will, change over time. But you can always change your Part D plan during the annual enrollment period each year if your needs or the plan itself changes. The annual enrollment period runs October 15-December 7 each year. The plans do change each year in most cases, so it is a good idea to re-evaluate your plan each year, regardless of whether your medications have changed.

So, how do you compare the plans based on your medications? Medicare.gov, Medicare’s website, has a tool online that allows you to do this. Currently, we do this, as a free service, for our Medicare Supplement clients on an annual basis, although we do not sell most of the plans. But if you are not one of our clients or just want to run this comparison yourself, follow the instructions below:

  1. First, go to http://www.medicare.gov.
  2. Click on the orange button in the middle left of the screen that says “Find health and drug plans”.
  3. This brings you to a screen to enter your zip code. Enter it there and click “Find plans”. Select your county in the pop-up window if prompted to do so.
  4. Answer the two questions on the next screen and click “Continue to plan results”.
  5. This brings you to the “Enter your drugs” screen. You should enter them as completely as possible for most accurate results. Make sure you use the generic name if you are on a generic version. Use the correct dosage if possible.
  6. Once you have entered your medications, go to the bottom and click the orange button that says “My drug list is complete”.
  7. This brings you to step 3… “Select your pharmacies”. Select the pharmacy that you use now or would most likely use. This CAN have some effect on your co-pays, etc. so it is a good step to enter this accurately. Once you have done that, click the orange button that says “Continue to plan results”.
  8. This brings you to “Refine your plan results”. On this screen, check the box beside “prescription drug plans” and click “continue to plan results”.
  9. This brings up your plan results. These can be difficult to decipher, but the most important things to look at are the “Estimated Annual Drug Costs”. These take into account any medications that you entered, as well as the premium and deductible of the plans. By default, the plans are ranked according to lowest overall annual costs.

If you have any questions about this process or figuring out how to compare Part D plans OR if you wish to compare Medicare Supplements plans by email, please contact me on our website or call me at 877.506.3378.

Medicare Part D Comparison – Information Is Up on Medicare.gov

The Medicare Part D annual enrollment period starts on October 15. This is the one time of year that you can make changes to your Medicare Part D Rx coverage (unless you fall into one of a few exceptions, “Special Election Periods”).

In some year’s past, Medicare did not post the comparison information in advance of the enrollment period. In response to increasing numbers of “Baby Boomers” and computer-savvy Medicare-eligibles, this year Medicare.gov rolled out the 2013 data at midnight on October 1. This comparative information is essential in comparison the Part D drug plans. Compare the Part D plans on Medicare.gov.

If you are on a Part D Rx plan now, it is highly advisable that you compare the available plans to make sure you have the plan that is most advantageous for you. The 2013 plans have changed dramatically in some cases, although the overall “average” picture is that the plan premiums went up only slightly and benefits stayed relatively the same. That doe not account for each individual plan, which could have changed drastically or stopped/started covering some of your specific medications.

Although this time of year, the enrollment period, does not actually apply to Medigap (Medicare Supplement) plans, many people believe that it does. And actually, it is a good time to compare the Medigap plans, since many companies change their rates on a calendar-year basis. Also, when doing a re-evaluation of your Part D plan, it may make sense to “shop” your Medigap plan as well. These plans are Federally-standardized, so each company is required to offer the same coverage plan. Typically, rates can vary by as much as 50-70% from one company to the next. So if you have had your plan for more than a year, there is certainly some savings to be had. Compare 2013 Medigap plans.

If you would like Medicare-Supplement.US to provide this customized rate quotes information for 2013 Medigap plans, simply request the information online. The Medigap comparative information will be provided to you by email within an hour (during business hours). Not all companies release their rates online, so if you are comparing rates that way, it is imperative to understand that you are not viewing all plan options. If you have questions or would like to speak to someone directly, call 877.506.3378.

Comparing Medicare Part D – Why You Should and The Process for Changing Plans

Comparing Part D plans is an essential part of any sound financial strategy. Part D plans can change each year, and most do change on a regular basis. The coverage changes, the premium changes, and some plans may choose to discontinue coverage altogether. Insurance is an ever-changing industry, and this is never more true than in the case of Part D plans. Because of that, it is absolutely critical that you re-evaluate your Part D plan on an annual, or at the very least, bi-annual basis.

The biggest things that you need to look for when you are evaluating and comparing your Part D plan to other options are the premium, deductible and co-pays/coverage. While one plan may have a lower premium, note whether the deductible is higher and/or whether the co-pays are larger. Often, plans will put forth an enticing lower premium but have the plan loaded with a large deductible and high medication co-pays. This is okay for someone in good health, but if your health changes or if you are on a lot of medications, this is not going to be something that will benefit you in the long run.

Towards the end of the year, usually in September or October, you will receive a packet from your current Part D plan regarding the coverage for the following year. If you have not received this by the end of October, we recommend contacting the plan to notify them of this and obtain this packet. This will be required in order to make a careful and effective evaluation of the plan options. The packet will contain a comparative chart, showing how the plan is changing from the current plan year into the next year. It should be relatively easy to understand if the premium, deductible, or co-pay structures are changing. Also, if your medications are moving to a new “tier”, this is something that you can find out from the packet, and it will be important to know as you evaluate the plans.

Each year, you have the opportunity to change plans during the annual election period. It is my recommendation that you carefully evaluate the plan options each year, as these plans change very frequently. If you wish to make a change, you simply apply for the new plan. You cannot be enrolled in two plans at one time, so when Medicare processes your enrollment into the new plan, they also disenroll you from your old plan. The process is seamless and easy to do. It can be done online with Medicare, by calling 1-800-MEDICARE or by contacting the new plan directly.

If you have any questions about this process, Part D plans in general or Medigap plan options, please contact us on our website or call us at 877.506.3378.

This concludes our five-part series on Part D plans. Hope you have found it to be enlightening and beneficial. Part D is the most confusing, and least enjoyable, part of Medicare for most people. However, it doesn’t have to be. With a little knowledge of the Part D system, how it works and how to easily compare plans, you can save hundreds, even thousands, of dollars a year. And, that’s enjoyable for anyone!

Medicare Part D – How To Compare Plans

Comparing Medicare Part D plans is very easy to do, thanks to the technology that exists now. In the past, you may have to compare plans by looking through the formularies of many different plan options, comparing the co-pays, premiums, deductibles, etc. – not to mention the individual reputations and customer service of the different companies. Now, comparing the total annual cost of a plan for you and your specific medications can easily be done online.

In order to perform/receive this comparison, follow these step-by-step instructions:

  1. Go to www.Medicare.gov.
  2. Once on that website, click “Compare Drug and Health Plans” near the middle of the page.
  3. That will take you to the “Medicare Plan Finder”. On this page, enter your zip code and click “Find plans”.
  4. Answer the two questions on the next page and click “Continue to Plan Results”.
  5. This takes you to the page where you can enter your drugs. You do NOT have to do this; however, it is advantageous if you do. This whole process is designed to compare the plans based on coverage of your specific medications. So, enter your medications on this screen – make sure you select the dosage and select the appropriate generic name if you use a generic in lieu of a brand name drug. Once you are finished, select “My Drug List is Complete”.
  6. On the next page, select the pharmacy that you use. The ones that are in your zip code will show up by default. If you do not have a pharmacy that you regularly use or do not have a preference, you still have to select one for the purposes of this comparison. But it would not have a large impact, if any, on the results.
  7. On “Step 4 of 4: Refine your Results”, select the first option “Prescription Drug Plans” and click “Continue to Plan Results”.
  8. Now, scroll down to where you see “Prescription Drug Plans”. This is the results for the plans available in your area, ranked by their coverage of your specific medications. You can compare up to three plans side by side and sort the plans by various criteria. The “bottom line” number that you should consider is in the first column – “Estimated Annual Drug Costs”. The plans are typically ranked by that criteria by default. You can click on any specific plan to drill down deeper into the coverage and what the specific co-pays would be. Medicare also gives you the option of enrolling online on their website, as well as linking to the plan website and displaying the plan phone number, if you prefer to enroll one of those ways.

Although Medicare Part D is intimidating to many people and is very complex, comparing the Part D plans has gotten much easier over the last few years. You can do it all online, using information directly from Medicare (which comes from the plans themselves).

My agency (and maybe some others) do these Part D comparisons as a service for our Medicare Supplement clients. We essentially follow the steps above to execute a comparison based on your specific medication needs. If you want more information about Part D or Medigap plans, please contact us online or at 877.506.3378.

How Does Medicare Part D Work?

Medicare Part D, the part of Medicare that covers prescription drugs, is sold by private companies, who are authorized by the Government’s Medicare program to provide Part D plans. These plans are approved on an annual basis, and generally, are sold as an annual contract.

In most states, there are 30-40 plans that are offered and premiums range from approximately $15/month to $100+/month. So there is a big range. Likewise, there is a big variance in the benefits provided by the plans, so it is essential to compare based on your specific needs, medications, etc. The plans can, and often do, change each calendar year. If your medication needs change, the plan changes, or something changes about your health, you can, and should, re-evaluate the plans on an annual basis. You can change plans during the annual election period (AEP), which runs from October 15-December 7 each year.

Medicare Part D plans can typically be used at most “chain” pharmacies, and many plans also have a mail-order option. However, it is important to check with your current pharmacy, particularly if you use a local or independent pharmacy, to make sure that they accept your plan.

When you pick up your medications at the pharmacy, you will pay a co-pay amount that is called the “Initial Coverage Level”, unless you have not met your plan deductible or have entered into the “coverage gap”. If you enter into the coverage gap, which starts at $2930 in retail costs, you will pay a larger portion of the costs of your medication – 50% on brand name medications and 95% on generic medications.

Part D plans can be used nationwide, in most cases, at chain pharmacies that accept your plan. However, if you plan to be traveling, it is always a good idea to either take your medications with you or call ahead to make sure there will not be a problem picking up your medications where you will be.

Part D plans are an important part of your future financial security, as the average person on Medicare does need multiple medications at some point. That said, it is an optional part of Medicare. You do not have to enroll in a Part D plan. If you do not, though, there is a penalty that Medicare charges. The penalty is 1% per month that you don’t have a Part D plan. This 1% is applied to your premium when you do sign up for a plan. For example, if you decline a plan for a year, then you would pay a 12% penalty on your premium when you do sign up.

If you have any questions about Part D or want more information, please contact us on our Website. Or, you can call us at 877.506.3378.

 

What is Medicare Part D – An Introduction to Terminology and Framework

Medicare Part D is the part of Medicare that covers prescription drugs. If you are on Medicare, in order to have Rx coverage, you must have a Part D plan. “Original” Medicare (Parts A & B) do not cover prescription drugs.

Medicare Part D is sold by private insurance companies that are authorized by Medicare on an annual basis to sell the plans. Medicare sets forth a minimum set of guidelines that the companies have to work within, and the companies can decide how they want to tailor their plans (i.e. deductibles, premiums and co-pays) within those minimum guidelines.

To understand Medicare Part D, there are few terms that you need to know:

  • Retail Cost: Retail cost is the cost your Part D company has negotiated with the pharmacies for your medications. This cost can vary from company to company. If you do not have drug coverage or if your plan does not cover your medication, you will pay the retail cost for your medication.
  • Deductible: A deductible on Part D coverage works just like a deductible on any other insurance plan. This is the amount that you must meet in order for coverage to start. For 2012, the standard Medicare Part D deductible is $320. Plans can keep this deductible or they can offset it with their other benefits in order to reduce it or eliminate it entirely. It is important to understand whether your Part D plan has a deductible, and if so, what that deductible is.
  • Initial Coverage Level: Initial coverage level is the first tier of coverage after the deductible on Part D plans. In layman’s terms, this is your co-pay for your medications. After the deductible is met, this is the amount that you will pay at the pharmacy to purchase your medications. Many of the Part D plans also offer a mail-order option. The retail co-pay and the mail-order co-pay are typically different. For 2012, the initial coverage level runs from $0 in retail costs to $2930. When you are in that range of total retail costs for your medications, you will pay the initial coverage level amount (the co-pay).
  • Coverage Gap (also called Donut Hole): The Medicare coverage gap is more commonly referred to as the “donut hole”. This is “gap” in Part D coverage that is a feature of the Medicare Part D program. During this level, which runs from $2930 to $4700 (in 2012), you will pay a larger portion of the cost of your medications. Generally, when you are in this tier, you will pay 50% of the cost of brand name drugs and 95% of the cost of generic drugs. This “donut hole”, thanks to health care reform, is being reduced each year, until it is eventually eliminated.
  • Catastrophic Coverage: Once you go through the donut hole (after $4700 in retail costs), or coverage gap, you go into catastrophic coverage. Once you are in catastrophic coverage, you are responsible for only a small portion of the overall costs of your medications until the end of the year.
  • Annual Election Period: The annual election period is the period during which you can make changes to your Part D coverage. This is the only time you can change plans, unless you qualify for a SEP (see below). This period, contrary to popular belief, does not apply to Medigap plans.
  • Special Election Period: A special election period, or a SEP, is a period during which you can make changes to your Part D plan outside of the AEP. A few examples of SEP’s are losing employer coverage, losing other Part D coverage, moving to a new state, etc. There are numerous other SEP’s but these are the ones that are seen most frequently.

If you have any questions about Part D, Medigap or Medicare Supplements, please contact us on our website – Medicare-Supplement.US – or call us at 877.506.3378.

Come back tomorrow for Part 2 of our Part D series.

Medicare Part D Informational Series

Next week, we will be running a Medicare Part D informational series. Part D is the most confusing part of Medicare, and for most people, the most challenging to compare. We will be running 5 articles that I believe will be useful in comparing the plans and know how to choose the plan that best serves your needs.

Best sure to check back in or subscribe for updates so that you can stay up to speed on Medicare Part D.