When Signing Up for Part D Prescription Drug Plan, What Are Some Questions I Should Consider?

There are many things to consider before choosing a Part D plan. Depending on your needs, your financial situation, and your preferences, some of the following questions and guidelines may be more important to you than others.

  • Does this plan cover my drugs?
    • If you take a lot of prescription drugs, then choosing a plan that has your drugs on its formulary is an important first step. If a plan does not include your drug or drugs on its formulary, then you may end up paying out of pocket for the entire cost of the drug. You should create a list of the names of the prescriptions you take, their dosages, and whether they are brand-name or generic. This can help you sort through plans and choose the ones that cover your drugs.
    • You should also find out if there are any restrictions on your covered drugs, such as prior authorization, step therapy, or quantity limits. You can do so by contacting the plan or looking at the plan’s details in Medicare’s Plan Finder tool (see How Does the Medicare Plan Finder Work?). It is important to note these as they may affect your ability to access your drugs at the pharmacy and may require you to speak to your doctor.
  • What are the costs associated with this plan?
    • If you choose a plan with a deductible, know that you will have to pay that amount out of pocket before your plan begins to cover your prescription drugs. Some people prefer to have a deductible if it means their monthly premium will be lower, while others prefer to pay a higher monthly premium instead of paying out of pocket to meet the deductible. You should also think about the most you can and want to spend on the drug plan’s monthly premium.
    • It is difficult to predict the exact cost of your pharmacy copays and coinsurance amounts because a drug plan can make some changes to coverage mid-year, and the negotiated price can change, but you can still evaluate plans based on your estimated out of pocket costs.
  •  Are my pharmacies preferred and in-network?
    • Many drug plans include both preferred and non-preferred pharmacies in their networks. You may pay less for your drugs at preferred pharmacies than at non-preferred pharmacies. If you go to a pharmacy that’s close to your home or easy to get to, it may be beneficial to look for a plan that categorizes that pharmacy as a preferred in-network pharmacy.
    • Some plans have a mail order option that may have cheaper prices than your pharmacy. If you prefer mail order, you can look for a plan that includes that option. If you prefer to pick your drugs up at the pharmacy, be aware of your plan has a mail-order option, and if it will affect your coverage in any way. For example, some plans may require you to opt-out of mail order before you can pick up your drugs at the pharmacy.
  • What is the plan’s star rating?
    • Medicare uses a star rating system to measure how well Part D plans perform in different categories, including quality of care and customer service. Ratings range from one to five stars, with one being the lowest and five being the highest rating. Medicare reviews plan performances each year and release new star ratings each fall. You can find a plan’s star rating by using the Plan Finder tool.
    • Star ratings are not the only factor you should consider when looking for a plan. Even though a plan has a high star rating, it may not be right for you if it does not cover the drugs you need. However, star ratings can be a factor you consider once you find the plans that will provide the best coverage for you.

Read Next: If I Already Have Prescription Drug Coverage Do I Need a Part D Prescription Drug Plan?
Find Out: When Do I Sign Up for Part D Prescription Drug Plans?
Return to: Medicare Part D

This content was created and copyrighted by the Medicare Rights Center ©2021. Medicare Rights Center is a national, nonprofit consumer service organization that works to ensure access to affordable health care for older adults and people with disabilities. These materials are presented here with support from YourMedicare.com and may not be distributed, modified or edited without Medicare Rights’ consent.

YourMedicare.com takes pride in providing you as much information as possible concerning your Medicare options, but only a health insurance broker licensed to sell Medicare can help you compare your plan options from various insurance companies. When you’re ready, we recommend you discuss your needs with a YourMedicare.com Licensed Sales Agent.