Comparing Medicare Part D Plans
Medicare Part D is a standalone health insurance plan from a private insurer like Anthem that provides outpatient prescription drug benefits that can save you money. Original Medicare Parts A and B don’t include prescription drugs unless they are prescribed to you during a hospital stay. So it can be a good idea to explore this option if you regularly take prescription medications.
Are Medicare Part D plans all the same?
While prescription drug plans provide at least the standard level of coverage as it is defined by Medicare, they have the option to offer different combinations of coverage and cost sharing.
Because Medicare Part D comes from private insurers like Anthem, you have the flexibility to compare plans and select one that fits you. Compare Medicare Part D plans by just asking a few questions when you shop for insurance.
What prescription medications are covered?
Every Medicare Part D plan covers different types of medications. If you use prescription drugs to manage a health condition like high blood pressure or diabetes, make sure your plan covers the medications you need most.
Medicare Part D insurers have drug lists of medicines they cover. If a plan does not cover your medicine, see if it covers a different drug that also works for you. Your doctor may know of a substitute or generic option to your medication.
What medications are not covered by Medicare Part D?
Medicare does not allow Part D insurers to cover certain types of drugs. These include:
- Non-prescription medications
- Medications for anorexia, weight loss, or weight gain
- Drugs used to promote fertility
- Drugs for cosmetic purposes or to promote hair growth
- Cough or cold medications
- Prescription vitamins and minerals
- Drugs for sexual or erectile dysfunction
Does a Medicare Part D plan have any restrictions on coverage?
Check to see if a plan has certain restrictions on the medicines you need, such as prior authorization and step therapy. Prior authorization requires your doctor to get permission from the insurer to prescribe certain medications. Then, the drug will be covered if your insurer pre-approves the medicine. Step therapy means you try less expensive medications to treat a condition first before trying more costly medications.
What is the average cost of a Medicare Part D plan?
Once you’ve found plans that cover the medications you use, compare the costs of those medicines. The price of prescription drugs often varies from plan to plan.
What other Medicare Part D costs should you know about?
Look at the copays, coinsurance, monthly premiums, and deductibles across different plans, in addition to ensuring your medications are covered. You may want the lowest annual cost not only for premiums, but also for your estimated annual out-of-pocket costs.
Will your medications be covered in the donut hole coverage gap?
Most drug plans currently have a coverage gap, also called a “donut hole.” It sets a temporary limit on what your plan will pay for medications.
Check to see if your medications will still be covered during the coverage gap or if your Part D plan has added benefits in the gap. The Medicare Part D 2021 limit is $4,130. While in the coverage gap, you are responsible for a percentage of the cost of your drugs.
Are you eligible for Extra Help for Medicare Part D?
See if you qualify for federal assistance to pay for Medicare Part D costs. Depending on your income, Extra Help is a federal program that can pay for some or all of your prescription drug costs.
Can you get generic medications?
Using generic instead of brand name drugs will help you save money. Make sure the prescription medications you use are available in generic form.
Does the Medicare Part D plan have a pharmacy network?
Check to see what pharmacies are included in a plan to fill your prescriptions and if it’s convenient for where you live. You may pay less by using a pharmacy in the plan’s network. You may save even more using a preferred cost-sharing pharmacy, if available. These are some retail pharmacies within the network of pharmacies that may offer you lower copays.
Does the Medicare Part D insurer have a five-star rating?
Medicare gathers performance reviews on Part D insurers from customers like you. A five-star rating helps you select a preferred insurer. Look for the star rating when you are shopping for plans.
Compare Medicare Part D with Medicare Advantage
Medicare Part D is not your only option. You could sign up for a Medicare Advantage Plan, also known as Part C, instead. Many Medicare Advantage plans include prescription drug coverage through a combined Part C and Part D plan, plus a lot more. Just like Medicare Part D plans, you can get Part C plans from private insurers like Anthem.
Medicare Advantage plans also offer the same coverage as Medicare Part A and Part B, plus vision, dental and hearing care, wellness programs, and gym memberships.