6 Tips to Help you Choose and Keep the Right Medicare Prescription Drug Plan

Medicare Prescription Drug PlansIf you are enrolled in a Prescription Drug Plan (Medicare Part D), either as a stand-alone plan or through your Medicare Advantage Plan, do you ever “check around” periodically to make sure you are in the right one?

If you are  new to Medicare and need a Prescription Drug Plan, how can you be reasonably be sure you will pick the right one?

These are good questions; ones our clients ask us on a regular basis, especially during open enrollment when all the brochures from insurance carriers flood your mailbox.

Well, below are 6 tips that make choosing and checking up on Medicare Prescription Drug Plans a whole lot clearer…


Keep Tabs on the cost of the plan regularly.  Most Medicare beneficiaries consider the premiums and deductibles when initially selecting a Part D plan, but they don’t continue to shop around for the lowest cost plan each year, according to recent findings from a series of focus groups with Medicare  recipients conducted by the Kaiser Family Foundation.  Seniors in the focus groups said they expected their premiums and copays to rise and would only start looking for a new plan if the price increase reached around $75 more a month.  It takes a lot for people to make a change and insurers know that, so they can raise their premiums, but not so much, if they want to keep people in their plan.

Check other formularies . Medicare Part D plans have lists of covered medications called the formulary, which are adjusted from year to year. Seniors who need medications that aren’t on their plan’s formulary are often willing to try a number of workarounds including an alternative drug or a generic version that is covered, medication samples from a doctor’s office, applying for discounts from drug manufacturers, appealing the insurer’s decision not to cover the drug and ordering medications online. Many seniors perceive the process of trying to find a new plan that would better suit their needs as too tedious and complex. This was another finding of the Kaiser Family Foundation study.

Don’t rely on just a plan’s brand name. A prescription drug plan’s brand name matters to some Medicare beneficiaries. Retirees told the study they felt reluctant to select a Part D plan from a company they had never heard of, even if that plan offered better benefits at a lower cost. Many retirees had both good and bad associations with large organizations, including AARP, Blue Cross Blue Shield, United Healthcare and Aetna, that influenced their plan choices.

Don’t rely on just a spouse’s plan. Married beneficiaries often prefer to have the same Part D plan or same insurer as their spouse. Retirees said it was more convenient to keep track of the rules for a single plan instead of two, even when separate plans might better cater to their individual health needs.  Many seniors implied in the study that they  just could not imagine having two sets of rules for two different plans.”

Learn about star ratings. Medicare ranks its prescription drug plans based on quality, with five stars being the best possible rating. But most seniors admitted that they didn’t know about the quality ratings. Seniors said that their own experience with the plan was more important to them than the plan’s quality rating.  However, the star ratings and the change in the ratings for certain insurance companies can sometimes be a better indication of a plan that would be a better fit for you.  You can check out the star ratings of plans in your area using Medicare’s plan finder tool.

And finally, the tip that will make using the above tips a whole lot easier to do…

Get personal, professional service. Many seniors said good customer service, especially in person, would make them more likely to choose a specific insurance provider, while poor customer service early on would make them more likely to switch. “Many seniors relied upon insurance agents to help them pick a plan, and the idea of having this in-person help was so appealing to seniors that oftentimes after the focus groups they were providing their insurance agent’s contact information to other seniors that wanted it. An experienced, competent agent can, more often than not, make the difference between being in a responsive Prescription Drug Plan that keeps your out-of-pocket cost to a minimum, and one that provides only mediocre help.


If you would like a way to compare Prescription Drug Plans, or get advice on other Medicare solutions, give our office a call at 415-999-5071

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