How do I chose a health insurance provider for my Medicare Part D Plan

Tamera Jackson by Tamera Jackson | Licensed since 2007
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This article was updated on: 10/06/2018

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If you’re approaching Medicare eligibility and considering your coverage options, you’ve probably thought about your Medicare Part D Plan for prescription drug coverage. The good news is that you may have a lot of options when it comes to choosing a Medicare Part D plan. Here’s what you need to know when you are selecting a health insurance provider for your Medicare Part D plan.

How much do Medicare Part D plans cost?

Medicare Part D Plans are offered by private insurance companies approved by Medicare, which means that each company sets its own cost structure. There are three elements to consider in comparing plan costs: The monthly premium, the yearly deductible, and the coinsurance or copayment structure.

Unless you get your prescription drug coverage through a Medicare Advantage plan, you’ll generally pay a separate monthly premium to your insurance company for Medicare Part D.

Your plan may also have an annual deductible, although many plans do not. A deductible is the amount you pay out of pocket before the plan begins to pay. The deductible varies by plan, but cannot exceed the limit set by Medicare each year. You’ll also have cost-sharing with your coverage. Some plans use a copayment system, where you pay a flat fee for each prescription. Other plans use coinsurance, which is a percentage of the actual cost of the prescription. Many plans use a tiered copayment or coinsurance system, where you pay a lower amount for less expensive generic prescription drugs and a higher amount for costly brand-name prescription drugs.

Will Medicare Part D cover all my prescription drugs?

All plans must cover certain prescription drugs and certain classes of prescription drugs as required by Medicare. Beyond that, companies may choose to cover other medications, as well. The list of prescription drugs covered by a Medicare Part D Plan is called a “formulary.” If you take prescription drugs on a regular basis, you should check the formulary for any plan you are interested in to be sure your medication is covered. The formulary may change at any time, but the plan must notify you when necessary.

If your exact medication isn’t covered, there will be similar prescription drugs in most cases. If your doctor believes that a particular medication is the only one suitable for your particular condition, she can request an exception to your plan’s formulary.

Some plans may have special coverage rules for certain types of medications. For example, you may have to try a lower-cost medication for a period of time to see how you respond before your plan will cover a higher-priced, similar drug. Some plans may require prior authorization for certain drugs. Your plan may also place a limit on the number of pills or doses of medication you can get at one time.

Will I have to use a different pharmacy with my Medicare Part D Plan?

Some plans do use a provider network to help keep costs low for their members. In some cases, the plan may not pay at all if you go outside the provider network, and in other cases, the plan will pay something, but you’ll pay more out-of-pocket if you go outside the network.

If you regularly use a particular pharmacy, it’s a good idea to check with any plan you are considering to make sure you can still use it after you enroll.

Need more information about Medicare Part D?

I am happy to help you find the information you need; you can schedule a phone call or request an email by clicking on the buttons below. You can also find out about Medicare plan options in your area by clicking the Compare Plans button.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.

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