Medicare Prescription Plans

About Medicare Prescription Plans

When choosing Original Medicare, individuals need to enroll in a Part D Drug Plan, as well as a Medicare Supplemental Plan. The best Drug Plan is unique to every individual, based on their medications and where they prefer to purchase their medications. Drug Plans are offered by private carriers, and drug coverage should be evaluated every year during annual enrollment (10/15 – 12/7), as plans and medication needs can change.

Considerations of Medicare Prescription Plans

Too many individuals enroll in a Drug Plan without understanding that there is a process to identify the most cost effective plan for their needs. The “best Drug Plan” is unique to every individual based on their needs, and can change each year. Therefore, whether you’re enrolling for the first time, or for following years, an assessment to identify the most cost effective coverage is critical, every year!

How We Can Help

When new to Medicare, Senior Advisors can identify the best Part D Plan for your needs. We can help to ensure that you’re paying as little as possible for your medications. This is a critical exercise for new Medicare cardholders, and it’s just as critical to evaluate this every year, as medication needs, and Part D Plans can change every year.

Every year during annual enrollment (Oct 15 – Dec 7), we proactively remind our clients to evaluate their drug coverage for the upcoming year, to help ensure that they aren’t overpaying. We provide updates regarding calendar year changes, and we are always available as an expert resource in-case you have questions.

KEY TAKEAWAYS

When choosing Original Medicare along with a Medicare Supplemental Plan, a Part D Drug Card is required as insurance to help pay for your medications
The best Medicare Drug Plan is based on your specific needs (location, medications, and preferred pharmacies)
An annual assessment should be performed every year during annual enrollment (10/15 – 12/7) to ensure that you are not overpaying for your medications

ADDITIONAL RESOURCES

Identify the best Drug card for your needs at Medicare.gov

The best Part D Plan for you, is ONLY determined based on your Medications. This video walks you through how to compare all Part D Plans available in your area, against your Medications.

This video first explains how to identify the best Part D Plan if you’re not taking medications, and then progresses to how to identify the best Part D Plan if you are taking medications.
You should create an online account with medicare.gov so your medication information will be saved, for future use

Choosing your Part D Plan

It’s important to identify the best Part D Plan, every year during Annual Enrollment (Oct 15 – Dec 7).

Plans can change every year, so while you may be happy with your current coverage, your current Part D Plan may be changing.

This video walks you through:

Seeing what your current Part D Plan will look like for the following year (premium and coverage details).
Enrolling in your Part D Plan

Enrolling in Your Part D Plan during Annual Enrollment (Oct 15 - Dec 7)

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Medicare Part D FAQs

I'm not taking any medications; do I need to enroll in Part D?

Yes, when enrolling in Medicare, if you don’t enroll in Part D within your enrollment window (three months prior to birthday month, birthday month, and three months after birthday month), and you don’t have credible coverage from another source, you will be penalized for the remainder of your life when you do enroll in Part D.

If you miss your enrollment window and you enroll at a later time, you will be penalized 1% of the current year Part D average monthly premium, for every month you did not have coverage.

Example:

Mr. Smith is currently eligible for Medicare, and his Initial Enrollment Period ended on June 30, 2021. He doesn’t have prescription drug coverage from any other source. He didn’t join by June 30, 2021, and instead joined during the Open Enrollment Period that ended December 7, 2023. His drug coverage was effective January 1, 2024. Since Mr. Smith was without creditable prescription drug coverage from July 2021–December 2023, his penalty in 2024 was 30% (1% for each of the 30 months) of $34.70 (the national base beneficiary premium for 2024) or $10.41. Since the monthly penalty is always rounded to the nearest $0.10, he paid $10.40 each month in addition to his plan’s monthly premium.

Here’s the math:

.30 (30% penalty) × $34.70 (2024 base beneficiary premium) = $10.41

$10.41 rounded to the nearest $0.10 = $10.40

$10.40 = Mr. Smith’s monthly late enrollment penalty for 2024

How do I determine which Part D plan is best for me?

The best Part D plan for you is the plan that will help minimize your medication costs for the year (including medications & plan premium). Your medications align with plan formularies, and one plan is likely better than others.

We can help you identify the best Part D plan for yourself, and you can also do this on your own, by using the medicare.gov website.

The best plan minimizes your medication costs, when including your medications AND the plan premium, combined.

It seems that a $0 Part D plan is being recommended for me; is this ok?

Yes, the quality/coverage of a Part D plan is not reflected in the premium. In some cases a $0 plan is better for an individual compared to a $100 plan, and in some cases the opposite is true.

If it is determined that a $0 plan is best for you, based on your medications, this is the plan that you should enroll in.

You can’t determine which plan will be best for covering unknown future medications.

Can I change my Part D plan later in the year if a new medication is prescribed?

Typically, you can only change your Part D between October 15th and December 7th, for the following calendar year.

However, if you are moving to a different state, you need to change Part D plans within 63 days of moving.

If you have a new medication prescribed that is expensive with your current Part D plan, but may be covered at a lower cost with another Part D plan, you will need to wait to change plans.

Do spouses typically have the same Part D plan?

No, spouses do not typically have the same Part D plan.

The best Part D plan is specific to each individual and the medications they take.

Enrolling in the same Part D plan as your spouse, just because it’s the same plan, can result in overspending.