Shopping for Medicare Part D: It’s that time again

Posted 10/6/21

REGION — Not happy with your current Medicare plan? The time to make changes is approaching fast.

From October 15 through December 7, Medicare recipients can make changes to their coverage. …

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Shopping for Medicare Part D: It’s that time again

Posted

REGION — Not happy with your current Medicare plan? The time to make changes is approaching fast.

From October 15 through December 7, Medicare recipients can make changes to their coverage. All changes take effect in January 2022.

You can stay with what you have, of course. But it never hurts to shop around.

Start with Part D. That’s the prescription drug benefit, the part of Medicare that covers most outpatient prescription drugs. It’s offered through private companies, either as a stand-alone prescription drug plan if you’re enrolled in Original Medicare, or as a set of benefits if you have Medicare Advantage.

Part D is one area of Medicare where you should sit down, look at the paperwork, and make sure it covers your healthcare needs.

First, make a list of all the prescriptions you take, including dosages and what you’re paying now. Include the pharmacies you use.

Now, ask yourself the following questions:

Drug coverage

Are my prescriptions on the plan’s formulary? The formulary is the list of prescription drugs for which a Part D plan will help pay.

Does the plan impose any coverage restrictions, such as prior authorization, step therapy, or quantity limits? Prior authorization means that you must get approval from your Part D plan before the plan will pay for the drug. Step therapy means that your plan requires you to try a cheaper version of your drug before it will cover the more expensive one. Quantity limits restrict the quantity of a drug you can get per prescription fill, such as 30 pills of Drug X per month.

What if something you take isn’t listed? Ask your doctor if something else on the list will also work.

Costs

How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need?

How much will I pay for monthly premiums and the annual deductible?

How much will I have to pay for name-brand drugs? How much for generic drugs?

What will I pay for my drugs during the coverage gap?

If a drug I take has a high coinsurance, is there a drug I can take that will cost less? (Ask your doctor.)

Am I eligible for Extra Help or a State Pharmaceutical Assistance Program like EPIC?

Pharmacy network

What is the service area for the plan?

Can I fill my prescriptions at the pharmacies I use regularly?

Can I fill my prescriptions when I travel?

What will my coverage options and costs be if I visit out-of-network pharmacies?

Can I get prescriptions by mail order?

Coordination with other insurance

Will Part D work with other coverage I have to lower my costs?

Do I need to enroll in Part D if I have other creditable coverage?

Do I need to enroll in Part D if I have job-based drug coverage?

There is no one best Part D plan for everyone. Instead, you should ask questions and make sure to find a plan that meets your specific health care needs. If you have questions, call the Office for the Aging at 845/807-0241.

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