Which Medicare Part D prescription drug plan should I choose?

  • October 24, 2015

Q: Which Medicare Part D prescription drug plan should I choose?

A: You have a two options for Medicare prescription drug coverage, and in both cases, they’re provided by private health insurance carriers, since outpatient drugs are not covered under Medicare A or B.

  1. You can sign up for a Medicare PDP (prescription drug program) through a private carrier, supplementing your Original Medicare (Part A and Part B) program.
  2. You can enroll in prescription drug coverage as part of a Medicare Advantage plan. With an Advantage plan (provided by a private insurance company) your coverage will include Medicare Part A, Medicare Part B, and – in most cases – prescription drug coverage, though the cost may be higher than if you used Medicare services exclusively.

If you want to use a PDP to supplement Original Medicare, you can sign up for a PDP when you become eligible for Medicare. (If you don’t sign up when you’re first eligible, you could end up paying a penalty.)

Review common situations encountered by those considering prescription drug coverage.

Each year between October 15 and December 7, you have an opportunity to review the PDPs and Medicare Advantage plans available in your area, and switch to a new one if you choose to do so.  If you join a PDP or Medicare Advantage plan between October 15 and December 7, your prescription drug coverage kicks in January 1.  It’s important to keep in mind that formularies (the covered drug list) can change from one year to the next, so the plan that presented the best value this year might not be the best value next year.

In addition, premiums can change from one year to the next, making a plan a better or worse value when compared with the other available options for the coming year.  The plan with the lowest premium doesn’t necessarily provide the best value, because you may incur higher out-of-pocket costs when you get your medications.

Medicare has a plan finder tool that lets you enter the medications you take and it will help you sort through the PDPs in your area to determine which ones will provide the best coverage based on your own prescription needs.  It’s important to repeat the process each year during open enrollment, even if your medications haven’t changed – because the formularies for the PDPs may have changed, along with their premiums.