What You Should Know About Choosing a Medicare D Plan

As we age or develop chronic medical challenges, prescriptions often claim a significant chunk of monthly income. Fortunately, for people 65 and older, Medicare provides a voluntary option for prescription drug coverage—commonly known as a Medicare D plan.

Choosing the right Medicare D plan can seem overwhelming, but there’s a lot of help available. Here are some of the key points to understand as you weed through the alternatives.

When Should I Enroll in Medicare D?
There are several steps to Medicare enrollment. You can join Medicare A (inpatient hospital coverage), Medicare B (outpatient medical services) and a Medicare D drug plan during the three months before you turn 65 or for up to three months after your birthday. You can also join at other times under certain special circumstances.

Please note that if you don’t enroll in a Medicare D plan when first eligible and then need the coverage, you’ll pay a penalty in increased monthly premiums. Again, there are some exceptions.

How Do I Choose the Right Medicare D Plan?
There are two basic categories of Medicare D plans:

  1. Medicare Prescription Drug Plans (PDP) These are free-standing insurance plans that cover prescription drugs. You would select a PDP if you have original Medicare (A or B) or a Medicare plan that does not include drug coverage.
  2. Medicare Advantage Plans with Prescription Drug Coverage (MA-PD) These are also known as Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee for Service plans (PFFS), or Special Needs Plans (SNPs). You would select an MA-PD if you wanted to combine your medical benefits coverage with your prescription drug plan.

There are multiple options available for both free-standing and Medicare Advantage plans in each state and pros/cons to each type of plan. As you sort through your alternatives, keep these factors in mind:

  • What drugs are you on? You may want to speak with your physician about changes that could reduce costs.
  • What pharmacy do you want to use? You need to be sure your pharmacy accepts the plan you’re considering.
  • How much does the plan cost?
  • Do you want to go “à la carte” with a free-standing prescription drug plan (PDP) or choose one that combines medical benefits and prescription drug plans (MA-PD)?
  • Are you on a retiree plan that limits your choices?
  • Does your choice of plan affect your spouse’s plan? Be sure you understand the details of how the two interact.

Where Can I Get Help?
There are several excellent tools available to help you examine all of the plans and analyze your options. As a care manager, I have used all of these tools with great success:

The Medicare website, www.medicare.gov, has a user-friendly tool called the Medicare Plan Finder. You enter the list of your prescription medications (including specific names and doses) and the name of your pharmacy. The tool will tell you which plans are available and how much each will cost. You can compare several plans.

You can also call the Massachusetts College of Pharmacy and Health Services Pharmacy Outreach Program at 866-633-1617.  Professional case managers and pharmacists will help you review your medications and analyze your options.

If you live here in the Commonwealth, the Massachusetts Executive Office of Elder Affairs SHINE program has a team of trained volunteers who will help you review plan options, discuss health insurance concerns, work through the applications for the drug plans and much more. You can locate a SHINE volunteer in your community by calling 1-800-AGE-INFO (or 1-800-243-4636).

A Few More Tips

  • For most people, the time to join or switch plans is October 15 to December 7 of each year. Your coverage will begin January 1. There are exceptions to these dates.
  • If you make less than $16,755 ($22,695 for a couple), you should apply for Extra Help using www.benefitscheckup.com.
  • You can join a plan through the Medicare.gov Plan Finder site or through the drug plan’s website.
  • You can also call the plan you want to join and either enroll over the phone or request an application.
  • You can enroll by calling Medicare directly at 1-800-633-4227.

For a more detailed explanation of Medicare benefits, visit the online Medicare Rights Center.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified geriatric care manager. Drawing on more than 30 years of professional experience in geriatric care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact usto set up a complimentary initial telephone consultation.

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