What questions should I consider before signing up for a Part D plan?

Emily WhicheloeDear Marci0 Comments

pharmacy-medicine
Dear Marci,

My mother is going to be eligible for Medicare soon. I want to help her choose a prescription drug plan, but I’m not sure where to start. What are some questions she should consider before signing up for a Part D plan?

Erin (Clark, NJ)

Dear Erin,

Choosing a Part D plan can seem daunting because there are many points to think about. Depending on your mother’s needs, her financial situation, and her preferences, some of the following questions and guidelines may be more important than others.

One question to ask is: does this plan cover your mother’s drugs? If your mother takes a lot of prescription drugs, then choosing a plan that has her drugs on its formulary is an important first step. A formulary is a list of drugs that a plan covers. If a plan’s formulary does not include her drug or drugs, then she may end up paying out of pocket for the entire cost of the drug. You can help your mother create a list of the names of the prescriptions she takes, their dosages, and whether they are brand-name or generic. This can help you sort through plans and choose the ones that cover her drugs.

You should also ask about the costs associated with the plan. If your mother chooses a plan with a deductible, know that she will have to pay that amount out of pocket before her plan begins to cover her prescription drugs. She should also think about the most she can and wants to spend on the drug plan’s monthly premium.

The Medicare Plan Finder tool and the plan your mother is considering should provide information about the expected copays or coinsurances for the medications she anticipates taking over the next year. It is, however, difficult to estimate the exact cost of pharmacy copays and coinsurance amounts because these may change over the course of the year.

Another question to consider is, are my mother’s pharmacies preferred and in-network? Many drug plans include both preferred and non-preferred pharmacies in their networks. Your mother may pay less for her drugs at preferred pharmacies than at non-preferred pharmacies. If she goes to a pharmacy that’s close to home or easy to get to, it may be beneficial to look for a plan that categorizes that pharmacy as a preferred and in-network.

Also note that some plans have a mail-order option that may have cheaper prices than the pharmacy. If your mother is interested in mail-order, she can also look for a plan that includes that option.

Lastly, your mother will want to ask, what is the plan’s star rating? Medicare uses a star rating system to measure how well Part D plans perform in different categories, including quality of care and customer service. Ratings range from one to five stars, with one being the lowest and five being the highest rating. Medicare reviews plan performances each year and releases new star ratings each fall. You can find a plan’s star rating by using the Plan Finder tool on www.medicare.gov.

Star ratings are not the only factor your mother should consider when looking for a plan. Even if a plan has a high star rating, it may not be right for her if it does not cover the drugs she needs. However, star ratings can be a factor to consider once your mother finds the plans that will provide the best coverage for her.

Knowing the right questions to ask can help you and your mother choose a Part D plan that works with her needs.

– Marci

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Developed by the Medicare Rights Center, Dear Marci is a biweekly e-newsletter that helps people with Medicare, their families, and caregivers understand Medicare benefits and options. Each issue features Medicare coverage advice, basic health tips and links to vital health care resources. Sign up today for the next issue.

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