Seeking Value: Looking Beyond Medicare Part D Premiums

Four simple rules for choosing the right plan for you

Updated on: August 29, 2018

Originally posted on: August 3, 2018
The Roadmap for Medicare staff specialize in all topics related to Medicare Part D, choosing a Medicare plan, and making smart health decisions in retirement.

When choosing a Medicare Part D prescription drug plan (PDP), you might assume that a low premium (the monthly amount you pay for the plan) equals a “good deal.” While it’s easy to compare premiums, there is much more to consider. To learn more about four simple rules of the road to keep in mind as you do your research, please watch this video.

How to Save Money on Your Prescription Plan


The amount you are required to spend on your medication before your plan’s coverage begins.

Plans with a high deductible, copayments and/or coinsurance (the amount you pay for your medications) may have lower monthly premiums, but could cost significantly more if you encounter unexpected or high medication costs. On the flip side, plans that have a higher monthly premium may offer money-saving options over the long term.

So, how do you know if a plan offers greater value? Look for these features:

  • Formulary: Look at the plan’s formulary — the list of covered drugs provided by the plan. Not all plans use the same formulary or drug list, so your top priority should be to find a plan that covers the medications, or clinically appropriate alternatives, you currently take.
  • Home delivery: If you take a medication on a long-term basis, check to see if you can receive your medications in the mail. A home delivery pharmacy service often costs significantly less when you fill a 3-month supply. Some plans even offer to ship for free.
  • Pharmacy networks with lower-cost options: Some plans offer lower costs at certain pharmacies within their larger pharmacy network known as “preferred” pharmacies. Plans that offer this low-cost feature can make a lot of sense if you travel or spend time away seasonally.
  • Pharmacist Support: Pharmacists are a great resource for helping you find cost-effective alternatives for your prescription medication needs, and can help you overcome any barriers to not taking your medications as prescribed. Taking your medications the right way can keep you healthy and help prevent additional healthcare costs, such as hospital or emergency room (ER) visits.

Customer Service Makes a Difference

Beyond these plan offerings, you also want to make sure that you’re getting the advice and care you need from your plan.

What to look for:

Preferred Pharmacy Network:

A select group of pharmacies within a broad overall pharmacy network where you can get your medications for a lower copayment.

  • A plan with knowledgeable Medicare advisors who will help you understand your plan and make sure you get the most value.
  • A plan with clinical specialists, such as pharmacists or nurses, who can help you better understand your medication and ensure you are getting the most benefit. These specialists help you avoid harmful drug interactions, manage side effects and find lower-cost medications.
  • Star Ratings: The Centers for Medicare & Medicaid Services (CMS) rate each Medicare Part D plan on its performance. A plan’s Star Rating is a good indicator of the quality and service you will receive. Look for a plan with 3 or more stars.