Category: Medicare Costs
3 Simple Steps to Stay Out of the Medicare Donut Hole
In a standard Medicare Part D plan, the third stage of coverage is the Coverage Gap (also known as the “Donut Hole”), when you will pay more for your brand-name and generic medications. You’ll want to avoid entering the Gap completely or at least delay your entry as long as you can. To learn more about the Coverage Gap and the other coverage stages for Medicare Part D plans, please watch this video.
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Keeping Track of Your Out-of-Pocket Drug Expenses
If you’re thinking about enrolling in a Medicare Part D plan, it’s likely you’ve heard the term “out-of-pocket,” which refers to the Part D expenses that aren’t reimbursed by insurance. A less familiar term, but one that is extremely important to Medicare Part D prescription drug plan members who enter the Coverage Gap, is “true out-of-pocket” or “TrOOP” costs.
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Medicare Prescription Drug Plans Vary by Hundreds of Dollars Per Year
Let’s face it – No matter how many times experts recommend that we reevaluate our Medicare Part D plan anew each year, many of us don’t! It’s just easier to stick with your current plan.
However, studies (or reports) show that those who take the time to research and switch to the plan that best fits their current needs often lower their out-of-pocket costs as a result of the change. A study estimated that beneficiaries who stay with their current prescription drug plan could pay, on average, a 13% premium increase.
We get it: Comparing plans can be confusing!
We understand why many beneficiaries hesitate to make changes. Reassessing your Part D plan during annual enrollment can be time-consuming and confusing. Keeping your current plan may seem like the road of least resistance. However, doing your homework to ensure your plan is still the best option for meeting your prescription drug needs might save you hundreds of dollars.
First, let’s settle this question: Why compare?
Each year, many of the details for your prescription drug benefit change. Your current plan’s premium, deductible and copayments or coinsurance may rise, while another plan may offer lower premiums or copays. These changes can affect your overall annual costs. And, while the premium may look good, there are other factors to consider before switching or staying with your plan.
In addition to pricing changes, the list of covered drugs (“formulary”) may change too. A drug that is covered one year may not be covered the next. Or, it might be moved to a higher tier, which means it may be more costly for you. If your medication needs have changed over the last year, or if you think you will need to increase or change the medications you are taking to treat one or more chronic conditions, you may want to consider evaluating your plan options.
Four Rules of the Road for Evaluating a Part D Plan
We’ve put together four simple rules below to help you on the road to picking the plan that’s best for you, or you can watch this video to help you along the way!
Rule #1: Lower premiums aren’t always better
- Plans with lower monthly premiums or a $0 deductible may have higher copays and cost you more overall.
- Prepare a list of all your medications to estimate your total costs as you compare plans. Be sure to talk to your doctor about your current medications to see if there might be any generic versions that might help lower your costs.
Rule #2: Make sure your medication is covered
Always check a plan’s formulary to be certain your medications will be covered in the next year. You can also see if the plan has any new rules like quantity limits or prior authorizations that may be required for your medications.
Rule #3: Find a plan with a pharmacy network that suits you
- A pharmacy network is the group of pharmacies you can use to fill your prescriptions — look for a plan with a large pharmacy network that includes both standard and preferred pharmacies. This is important especially if you plan to travel.
- Be sure the plan offers preferred pharmacies that charge lower copays and coinsurance to help lower your costs.
- Many plans also offer a home delivery pharmacy, a service that can provide you additional savings, plus the convenience of having your medication delivered right to your door.
Rule #4: Look for 24/7 pharmacist support
Immediate access to a pharmacist can be very important. Pharmacists can help with questions about drug safety, money-saving drug alternatives, and even offer expert advice for the medications that treat your chronic condition.
Use the Annual Enrollment Period to Your Advantage
Begin your research on October 1 by checking each plan’s website. Call the plan if you need more information or additional plan materials. This is your opportunity to ask questions and make sure you have the right prescription drug plan for the year ahead.
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A higher household income may mean a higher premium
You’ve done your research, enrolled in a Medicare Part D plan, and figured out your monthly premium payment. All set? Maybe not.
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