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How to Find a Better Medicare Prescription Drug Plan

Posted: 9/21/2017 8:12 AM by Interim HealthCare
Dear Savvy Senior,
I think I’m paying too much for the medications I take. I have a Medicare Part D prescription drug plan and my out-of-pocket spending is over $4,000 thus far in 2017. When and how can I change my Medicare drug plan?
Inquiring Carol

Dear Carol,
You can change your Part D prescription drug plan during Medicare’s open enrollment period, which runs from October 15 through December 7. During this time, beneficiaries can switch drug plans or join a drug plan if you didn’t have one before. They can also switch from Original Medicare to a Medicare Advantage plan, or vice versa if they wish. Any changes to coverage will take effect January 1, 2018.

In September, you should also keep your eyes peeled for your “annual notice of change” from your drug plan. It will outline any changes in coverage, costs or service that will take effect in January.

If you take no action during open enrollment, your current coverage will continue next year. Yet even those who are happy with their coverage should review their plan for any changes to come.


Change Medicare Plans

If you have Internet access and are comfortable using a computer, you can easily shop for and compare all Medicare drug plans in your area, and enroll in a new plan online.

Just go to Medicare’s Plan Finder Tool at Medicare.gov/find-a-plan, and type in your ZIP code or your personal information, enter in how you currently receive your Medicare coverage, select the drugs you take and their dosages, and choose the pharmacies you use. You’ll get a cost comparison breakdown for every plan available in your area so you can compare it to your current plan.

This tool also provides a five-star rating system that evaluates each plan based on past customer service records, and suggests generics or older brand name drugs that can reduce your costs.

When you’re comparing drug plans, look at the “estimated annual drug costs” that shows how much you can expect to pay over a year in total out-of-pocket costs, including premiums, deductibles and co-pays.

Also, be sure the plan you’re considering covers all of the drugs you take with no restrictions. Most drug plans today place the drugs they cover into price tiers. A drug placed in a higher tier may require you to get prior authorization or try another medication first before you can use it.

Need Help?

If you need some help choosing a new plan, you can call 1-800-MEDICARE and they can help you out over the phone. Or, contact your State Health Insurance Assistance Program (SHIP), which provides free one-on-one Medicare counseling. They also conduct seminars during the open enrollment period at various locations throughout each state. To find the contact information for your local SHIP visit Shiptacenter.org, or call the eldercare locator at 800-677-1116.


Low-Income Assistance

If you find yourself struggling to pay your medication costs, check out Medicare’s “Extra Help” program. This is a federal low-income subsidy that helps pays Part D premiums, deductibles and copayments. To be eligible, your income must be under $18,090 or $24,360 for married couples living together, and your assets must be below $13,820 or $27,600 for married couples. For more information or to apply, call Social Security at 800-772-1213 or visit SSA.gov/medicare/prescriptionhelp.

Other resources that can help include RxAssist.org, which maintains a comprehensive database of patient assistance programs, set up by drug companies for those who have trouble affording their medications. And NeedyMeds.org, a national nonprofit organization that maintains a website of free information on programs that help people who can’t afford their medications or other health-care costs.