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If you're paying a high premium for a plan you're hardly using, consider a lower-cost plan.

Four signs you need a new Medicare Part D plan

If any of these situations apply to you, open enrollment could be a great opportunity to swap your current Part D plan for another.

Reviewed by our health policy panel.

Key takeaways

If you’re enrolled in Medicare Part D, you’re no doubt aware that you have choices when it comes to the specific plan you buy. If any of the following situations apply to you, it could pay to swap your current plan for a different one during Medicare’s upcoming open enrollment (October 15-December 7).

1. Your current plan’s formulary has changed

All Part D plans have a formulary that places medications into different tiers. Drugs in a lower tier – usually generics – typically come with minimal copays. Some can even be copay-free. But the higher a tier you’re looking at for the medications you take, the greater your out-of-pocket costs will be.

Now here’s the problem with plan formularies – they can change from year to year. This means that a drug you take that starts out in a lower tier could get bumped into a higher tier in the future, thereby raising your costs substantially. If that’s the case with the Part D plan you’re on, then it could be time to switch.

2. Your medication needs have changed

It always pays to find a Part D plan that offers decent coverage for the specific medications you take. But once your prescriptions change, it absolutely pays to see if there’s a Part D plan that offers you a better deal.

For example, if you’re paying a relatively high premium for a specific plan that places one of your recurring medications in a relatively low tier, but you then switch to a generic version of that drug that’s cheaper across the board, it pays to see if you can get away with paying a lower premium.

Or, if you’ve switched to another medication that’s placed in a higher tier under your current plan, it pays to see if there’s another plan that has it in a lower tier.

3. The pharmacies included in your plan aren’t convenient

Part D plans typically charge higher copays at pharmacies that are considered out-of-network. If the plan you’re on doesn’t have at least one or two conveniently located pharmacies in-network, then that alone is a good reason to contemplate a switch. This holds true even if you have access to a mail-order program, since waiting for medications to arrive isn’t always an option.

4. You’re paying a high premium for a plan you’re hardly using

Sometimes, it’s worth paying up for a Part D plan that offers better coverage, because what you fork over in premiums, you make up for in copays. But if you don’t have any ongoing prescriptions, then you may be better off opting for a lower-cost plan.

Shop around

Some people stick with the same Part D plan and do well with it for years. But before you settle for your current plan, shop around and assess your choices.

You have the option to change your Part D plan during Medicare’s open enrollment, which runs every year from October 15 through December 7. If you change your Part D plan during that time, you’ll get to start off 2020 with a new one that could end up offering superior coverage at a lower cost.


Maurie Backman has been writing professionally for well over a decade, and her coverage area runs the gamut from healthcare to personal finance to career advice. Much of her writing these days revolves around retirement and its various components and challenges, including healthcare, Medicare, Social Security, and money management.

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