If you’ve been enrolled in a Part D plan for a number of years, now is the time to review it and make potential changes without penalty. Even if you’re happy with your current coverage, it’s wise to evaluate your plan and determine if another would better fit your needs.
When reviewing plans, look to compare the following:
Despite the news from the Center for Medicare and Medicaid Services (CMS) that premiums for basic Prescription Drug Plans (PDPs) offered in 2013 will remain flat, there is a significant fluctuation in premiums when enhanced plans are factored in. CMS expects the average 2013 monthly premium for basic prescription drug coverage to be $30, which is basically unchanged from 2012. Average Part D premiums for current plans, however, will increase by 6%, according to Avalere Health, a Washington D.C. consulting company. Some of the more popular plans from years past will have higher premiums, so it’s worthwhile to search for a new plan to avoid sometimes significant premium hikes.
The Humana Walmart-Preferred Rx Plan, for example, will increase costs by 23% to $18.50 per month. To balance increased premiums on several plans, there are also new low-cost options including AARP’s MedicareRx Saver Plus, which has premiums averaging $15 a month.
In looking at the overall cost of your plan, it’s important to factor in potential out-of-pocket expenses. In 2013 Medicare Part D plans are allowed to charge deductibles – a set amount you must pay for services before your insurance kicks in — of up to $325. Even after you’ve met your deductible, you may have additional copayments or coinsurance charges for covered drugs. Many times you’ll have to decide whether it’s worth paying a higher premium in exchange for a smaller deductible and copayment.
Each Medicare Part D plan has a list of medications, both brand and generic, that the insurance covers called the formulary. Prescription drugs are often grouped into tiers of covered drugs that have different out-of-pocket costs. To see whether your copays might change or if there are any formulary changes, you should go to medicare.gov to the “Plan Finder” and enter the drugs you are taking. By switching to a new Part D plan, you may save a significant amount of money.
Some Part D plans require prior authorization before you can fill a certain prescription and may have quantity limits regarding how much medication you can get at one time. You may also be required to try lower-cost drugs before the plan will cover a more expensive prescribed drug. So, if there’s a specific drug you need, it’s worthwhile doing pre-work to determine which plan covers it and how much it will cost.
In addition, most plans have a network of pharmacies they want you to use in order to get the best prices. If you go to a pharmacy that’s not in your plan’s network, you may have to pay more for your prescriptions. Make sure your preferred pharmacy is in your plan’s network.
Donut Hole Gap
A Part D plan will stop paying for a portion of your medications once a pre-set spending limit is met. At this point, you have reached the “donut hole” and are responsible for paying 100% of your drug costs. Seniors who reach the donut hole gap in prescription drug coverage in 2013 will get 52.5% off the cost of brand-name drugs and 21% off the cost of generic drugs, up from 50% and 14% in 2012. If you know you’ll need a number of prescriptions, it may be worth the cost of the extra premiums to have the gap coverage.
One final consideration when selecting your Part D plan is convenience. If you have a Medicare Advantage plan with prescription drug coverage, there’s just one company to contact if there’s ever an issue with your coverage. If your prescription drug plan is with a different carrier than your other Medicare coverage, it may be more difficult to coordinate benefits between plans.
The Medicare insurance experts at MedicareSolutions are available to help you find a prescription drug plan that fits your needs. Just tell us where you live and the medications you’re currently taking, and we’ll find a drug plan that works for you. Call us today at 1-800-328-7305!