How do I Choose a Medicare Part D Plan That is Best for Me 

Pamela Cannaday by Pamela Cannaday | Licensed since 2011
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This article was updated on: 11/23/2018

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Medicare Part D is prescription drug coverage offered by private insurance companies. You can get Medicare Part D coverage through a stand-alone plan that works together with Original Medicare (Part A and Part B) or through a Medicare Advantage plan.

This article focuses on choosing a stand-alone Medicare Part D plan. The two main things to consider when choosing the best Medicare Part D plan are plan costs and plan benefits.

How to find the best Medicare Part D plan for the cost

Costs to consider when choosing a Medicare Part D plan are premiums, deductibles, and copayments/coinsurance.

  • A premium is the amount you pay monthly to have the plan. The average basic Medicare Part D premium is $32.50 in 2019, according to the Centers for Medicare and Medicaid Services (CMS). This amount is slightly less than it was in 2018. However, depending on the insurance company offering the plan, the area the plan is offered, and the specific coverage of the plan, your premium may be much lower than $32.50 (for example $19.70) or much higher (for example $44.20). Your Medicare Part D premium may also be affected by your income. Usually higher-income beneficiaries (a single income over $85,000 or a married income over $170,000) pay more for Medicare Part D coverage.
  • A deductible is the amount you pay for your prescription drugs before your plan begins to pay. Medicare puts a limit on what this deductible can be. In 2018, the maximum deductible was $405. Some Medicare Part D plans don’t charge a deductible.
  • A copayment is a dollar amount you pay every time you fill a prescription drug. A coinsurance is a percentage you pay when you fill a prescription. Copayment and coinsurance amounts vary according to the pricing tier the medication is on. For example, you might pay a $4 copayment for a tier 1 preferred generic medication and a 39% coinsurance for a tier 4 non-preferred medication.

Consider all costs before deciding what the best Medicare Part D plan is for you. For example, one plan might have a low premium and a $0 deductible, but high copayments/coinsurance. Another plan might have a higher premium and a $405 deductible, but lower copayments/coinsurance.

How to find the best Medicare Part D plan for the coverage

Different Medicare Part D plans may cover different prescription drugs. However, Medicare Part D plans must cover all or “substantially all” prescription drugs that are:

  • Immunosuppressant to prevent organ transplant rejection
  • Antidepressants
  • Antipsychotics
  • Anticonvulsants
  • Antiretrovirals
  • Antineoplastics

Medicare Part D mandates the coverage of these classes of prescription drugs to protect the “vulnerable populations” that take them. To know if your prescription drug is covered by your plan, ask for the plan’s formulary. A formulary is a list of covered prescription medications. If you have a plan that doesn’t cover a prescription drug you need, you can appeal for that medication to be covered.

Finding the best Medicare Part D plan for the customer rating

As you are searching for Medicare Part D plans, you may see that each one has a star rating, going from 1 to 5 stars. The star rating is an indicator of the plan’s quality and performance. Factors that go into the star rating include:

  • How well the plan handles member appeals
  • Member complaints and plan improvements
  • The plan’s management of chronic conditions
  • The plan’s provision of screening tests and vaccines

If you a see five-star plan with a higher premium than a 3-star plan, you may consider if the increased monthly cost is worth it for coverage that is rated highly.

Do you want to find a Medicare Part D plan in your area? Just enter you zip code on this page.

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