Medicare Part D: Making a Decision

When it comes to making a decision on a Medicare Part D prescription drug plan, there are many things that a beneficiary may think about. There are some that are worried about the affordability of monthly premiums. There are others that are worried about expensive medications being made available to them. No matter what the concern, it should always be addressed before enrolling into a prescription drug plan. If those concerns are not addressed, a Medicare beneficiary may face a nasty surprise at a time they can ill afford it.

During the annual enrollment period, anyone that has Medicare Part A or B can enroll into a Medicare prescription drug plan with any of the approved prescription drug plan providers. This is a period of time that will allow anyone to enroll, no matter how long they have been without coverage or when they became eligible. It is also the time of the year that existing drug plan members can change their drug plans without a reason and have their coverage continue in the new calendar year with a different company. This is a time that many Medicare eligible members are thinking of their options and deciding who will suit them best.

What to Consider

When it’s time to enroll into a prescription drug plan, there are many things that should be questioned. A Medicare beneficiary has to make a medically personal choice in a short amount of time. The choice that is made will affect them for the next calendar year. It’s an important choice.

One of the first things that beneficiaries should consider is the formulary. When they are looking at their drug plan options, they should check to make sure their medications are covered on the formulary. There are millions of eligible Medicare beneficiaries that assume all formularies are the same. This is the biggest misconception.

Every formulary is different. There are some medications that will be paid for by one company that won’t be covered under another company. This happens because each prescription drug plan provider has a board of pharmacists and other specialists that compile a formulary for them. They look at the medications that are Medicare approved and what their members seem to need the most and what’s filled regularly. From those lists, they make the decision of what will be covered on their formulary. Many people are surprised to learn there are different formularies for different plans, at different companies.

After a beneficiary has looked at the formulary, they should look at the cost of the Medicare prescription drug plan. Many times, people are surprised they have to pay a monthly premium for a Medicare prescription drug plan. This has to be paid to the insurance provider directly just as any other insurance. There are some insurance plans that are more expensive than others. What makes the prices change many times is the formulary of those plans. Many basic prescription drug plans will only cover 60-70% of Medicare approved medications. The more expensive plans may have a formulary that covers 80-95% of Medicare approved medications. The choice of plans will depend on what formulary a member’s medications fall under and how much a member can afford to pay each month.

As Medicare beneficiaries are considering the price of plans, it’s very important they know where their medications fall in a formulary. There are thousands of medications prescribed that are covered under a basic plan. Those plans are very affordable. If there is no need for an expanded formulary, many beneficiaries choose not to enroll in the more expensive plan. If a member has an expensive medication that is covered on the expanded formularies, they may have to enroll in one of the more expensive plans.

What to Do

Every Medicare eligible beneficiary that is enrolling into a Medicare Part D prescription drug plan has a responsibility to ensure they are getting what they want out of the plan they enroll in. If they are enrolling in a different drug plan, they should make sure their concerns and questions have been addressed before they enroll.

This is the time of the year that a beneficiary should contact the company they are interested in and ask questions. The representative they speak with should be able to tell them exactly how their prescription drug plan works, what is on the formulary, the difference in the plans and many other things. If there is information given that doesn’t suit a beneficiary, they should look to another company.

An insurance plan is designed to help those that pay for it. It is designed to help members of the public get medical services and medications at a more affordable cost. Those that are enrolling to a Medicare prescription drug plan should benefit from the plan they enroll in. Those that take the time to research their options will find a Medicare prescription drug plan that will benefit them through the year.

Nov. 6 13'
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May. 25 14'

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