The Differences in Medicare Part D Plans

With so many Medicare part D plans being talked about, thousands of people are left confused and wondering what the difference is. Most people are looking for certain things in their Medicare part D plans but are often talked to about other things. While all the details of a part D plan are important, sometimes it’s overwhelming to hear about so many options.

Medicare part D plans are very easy to understand. Simply put, Medicare part D plans are the Medicare recommended prescription insurance plans. These plans are not provided by Medicare but they are provided by Medicare approved insurance providers. These insurance providers have agreed to work with Medicare to provide these plans and offer specific benefits to Medicare members.

The insurance providers that are approved to offer Medicare part D plans have specific offerings and have to follow certain rules. No matter what insurance provider is offering the part D plans, the rules are the same. The rules for all Medicare approved insurance providers include:

  • Supervision from Centers for Medicare and Medicaid Services
  • Must provide coverage for at least 50% of Medicare approved medications
  • Must have a grievance and appeal process readily available for all members
  • Quarterly and annual reports of grievances and complaints to CMS
  • The same levels of coverage (initial coverage period, the donut hole, catastrophic coverage)

While those are only a few of the rules, they are very important for members to know.

Why So Many Plans with Little Differences

It seems all Medicare part D plans have the same benefits with slight differences. While it seems that all plans are alike with very little to set them apart, there are some important differences that people should be aware of.

The differences in Medicare part D plans start with the actual insurance providers. There are some insurance companies that have a better reputation for customer service and claims than other companies. For many people, this is very important because this is who they will be talking to when there is a question about the actual insurance coverage.

Another difference in the Medicare part D plans are the formularies. While it’s a CMS rule that certain medications be covered in the plans, not all formularies have the same medications covered. CMS gives insurance providers a huge list of medications they can choose to carry and the insurance company can decide what medications they will help their members pay for. In many instances, a cheap plan offers little protection in the way of expensive medications.

All Medicare part d plans have a donut hole. Members that run into the donut hole will have to pay the negotiated price of medications instead of the copays and coinsurance payments they are used to. The prices members have to pay during the donut hole are different at each insurance company because each insurance company can negotiate a different price from the drug makers. That is a stunning fact that many don’t realize until they have to pay for their medications.

While Medicare part D plans all look the same, they aren’t. There are huge differences that have to be thought about when choosing a plan. It’s confusing but it’s worth asking questions before deciding among all the Medicare part D plans available.

Dec. 2 14'
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Jul. 7 15'


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