Organize 2 Crucial Lists for Comparing Medicare Drug Plans - dummies

Organize 2 Crucial Lists for Comparing Medicare Drug Plans

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The information you must have at hand before comparing Medicare Part D plans properly — whether you hop online and use the Medicare plan finder yourself or get someone else to do it for you — is very simple. All you need is your zip code and the following two lists:

  • An accurate list of your prescription medications

  • A list of personal preferences that may make you lean toward one plan rather than another

Create an accurate list of your meds

Gather together all those bottles that contain the prescription drugs you’re currently taking — tablets, capsules, liquid solutions, sprays, creams, or whatever form they come in. (But leave out any medications you buy over the counter without a doctor’s prescription, as well as vitamins and supplements, because Part D doesn’t cover these items.)

Then make a list of the following characteristics, using the information provided on the labels. (Alternatively, if you use just one pharmacy, you can ask the pharmacist for a printout of all your prescription drugs.)

  • The exact name of each drug: Many prescription drugs have the same name but come in different forms, with differences marked by a second word or combination of letters following the name — for example, ER (extended release), SR (sustained release), or CR (controlled release). Part D plans may price these forms very differently from each other.

  • Dosage: Entering the wrong dosage in a plan search may distort your cost results. Part D plans often charge the same co-pay for different strengths of the same drug (for example, 10 mg, 20 mg, 100 mg), but not always.

    The full price of the drug (the price the plan pays the manufacturer) may also vary according to dosage, a situation that may affect what you pay if your plan has a deductible, if you fall into the doughnut hole, or if the plan charges a percentage of the full price rather than a flat dollar co-pay for your share of the cost.

  • How often you take your drugs (frequency): Of the three factors that can alter the results for your out-of-pocket costs during a plan search, frequency is the most important. If, by mistake, you indicate that you take a pill once a day when in fact you take it twice a day, the search results will show a cost that’s half as much as you’ll actually pay at the pharmacy.

    That’s one surprise you don’t want! On the flip side, if you take a drug once a week but mistakenly indicate that you take it once a day, the results will show an out-of-pocket cost seven times higher than what you’d actually pay. Neither of these situations helps you accurately compare plans.

It’s not just being persnickety remembering you should note the three items — name, dosage, and frequency — exactly as they’re written on the container label. Unless you enter correct information into the plan finder, your search results will be distorted and you won’t obtain accurate enough information to be able to compare plans properly.

These exact details are equally important if you ask someone else to help because that person is also going to use Medicare’s plan finder to assist you.

Draw up a list of your plan preferences

Finding a plan that covers all your drugs and costs you the least out of pocket may be top on your list of priorities. But chances are high that you’re going to identify several Part D plans that cover your drugs and vary by only a few dollars in the overall amount they charge. So consider some other factors that may be important to you, such as the following:

  • Does this plan restrict any of my drugs? Any plan may require you to ask permission before it’ll cover certain drugs through restrictions known as prior authorization, quantity limits, or step therapy. But plans don’t all restrict the same drugs, so you want to look for a plan that has the fewest restrictions on the ones you take (or, ideally, on none at all).

  • Does this plan have a good track record? Plans that provide quality service — answer calls without keeping callers on hold forever, respond to questions properly, pay their share of prescriptions correctly, and deal with complaints promptly — are obviously preferable. Medicare rates the plans so that you know in advance which are likely to give good service and which are best avoided.

  • Are the pharmacies in this plan’s network convenient to where I live? Each plan has its own network of pharmacies, and going to a pharmacy outside that network costs you a lot more (probably even full price) for your drugs. So you need to be sure that the plan you select has network pharmacies within a reasonable distance of your home.

  • Does this plan have preferred pharmacies in my area? Plans designate certain pharmacies as “preferred.” These pharmacies often charge substantially lower co-pays than the plans’ regular in-network pharmacies.

  • Does this plan have a mailorder option? If you prefer to receive all or some of your prescriptions by mail order in 90-day supplies (which costs less in many plans), you need to be certain that the plan offers a mail-order service. Some plans don’t.

  • Will this plan cover my prescriptions when I’m away from home? If you expect to travel during the year or live in another state for part of it, you need a plan that covers your prescriptions at network pharmacies throughout the United States. Some plans offer a national service and some don’t. (None cover drugs purchased abroad.)