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Medicare Part D Enrollment Tips: Choosing a Medicare Part D or Medicare Advantage plan

There is no one "right" way to choose a Medicare Part D or Medicare Advantage plan.  In general, we simply advise people to choose a Medicare plan that most economically covers their current health and prescription needs. But we can provide some general guidance ...


The basics of choosing a Medicare Part D or Medicare Advantage plan

In general, most people find that they choose a Medicare Part D or Medicare Advantage plan based on: Coverage, Cost, Convenience, Company, and Comfort.
  • Coverage - First, you want to ensure that your prescription medications are covered by this Medicare drug plan. Are there lower-costing generic alternatives available for your brand-name drugs? How large is the plan's formulary (or drug list)? If your chosen plan does not cover all of your medications, can you work with this plan to get a formulary exception? (Formulary Exception practices are also good to consider should you need a medication later next year that is not covered on the existing formulary.) What price-tiers apply to your medications? Are there any additional Usage Management restrictions? If you would like to have Medicare Part A and Medicare Part B coverage along with your Part D coverage, you might ask: What health coverage does the Medicare Advantage plan offer beyond basic Medicare? Are there any additional benefits offered by the plan? Are all of your doctors and specialist part of the Medicare Advantage plan's provider network?

  • Cost - What are the monthly plan premiums? Does the Medicare Part D plan or Medicare Advantage plan have an initial deductible? What are the co-payments or co-insurance that you pay for your medications or healthcare? What are the plan's coverage limits? Is there any prescription coverage in the Donut Hole?

  • Convenience - How difficult is it to find a pharmacy or a health care provider? (Note: most national Medicare Part D plans have a pharmacy network of over 50,000 pharmacies.) Are your restricted to any healthcare network (such as an HMO)? Do your doctors accept this Medicare Advantage plan? How easy is it to work with this Medicare Part D plan or Medicare Advantage plan?

  • Company - Is the company who provides the Medicare Part D or Medicare Advantage plan important to you? Often people choose a Medicare plan based only the Medicare plan provider's reputation or recommendation. Does the Medicare Advantage plan have a reputation of dropping doctors from their healthcare network? Does the Medicare plan have a reputation of changing coverage each year? What is the Medicare plan's overall and individual Quality or Star ratings?

  • Comfort - Would you rather not change plans each year? Are you comfortable with your current Medicare Part D plan or Medicare Advantage plan? Would you rather spend a few extra dollars per month because you know your healthcare providers, have an idea how your current Medicare plan operates, and your plan costs are predictable (even though slightly more expensive)?

Tip: How to get an overview of Medicare plan Coverage and Costs

Drug (Rx) Coverage and Cost: Both our Formulary Browser (showing all drugs for a single Medicare plan) and our Drug Finder (www.Q1Rx.com - showing all Medicare plans covering a single drug) display the average retail cost for medications, details of the drug utilization management restrictions, and with the drug cost-sharing information for all Medicare Part D plans and Medicare Advantage plans that include drug coverage. plans.

Medicare Advantage plan Coverage and Cost: Click on the plan name in our Medicare Advantage Plan Finder (MA-Finder.com) and see a summary of Medicare Part A and Medicare Part B coverage provided by the plan. Need additional assistance? We also show the plan's Member Services number at the top of the same page.

Remember: Retail drug prices can change throughout the plan year - even week-to-week and pharmacy-to-pharmacy. We provide an average of retail prices across all pharmacies in that plan's Service Area. Also, Medicare Advantage plan healthcare provider networks can change throughout the plan year. You can read more in our FAQ here: "Can I get a Special Enrollment Period if my Medicare Advantage plan drops my doctor from the plan's network?"

... Help, I am totally lost: No problem. You can always telephone a Medicare representative at 1-800-633-4227 and ask for unbiased assistance finding a Medicare plan that most economically covers your health and prescription needs.



But what if you do not need Medicare plan coverage?

For some people, choosing a Medicare plan may be based on your risk tolerance.  For instance, people who are not taking any (or only a few) medications, can look up the lowest costing Medicare prescription drug plan (or Medicare Advantage plan that includes prescription coverage), check for medication coverage, and decide whether they:
  1. Should enroll in a Medicare plan with the lowest priced monthly premium just to avoid any future late-enrollment premium penalty or

  2. Will pay a little more per month for a Medicare Part D plan with a $0 initial deductible and/or a larger formulary (drug list)and/or a more familiar insurance company name - just in case their health were to change during the plan year or

  3. Will not enroll in any plan this year, save the monthly premiums, and plan to pay the late-enrollment penalty if they ever choose to join a Medicare Part D or Medicare Advantage plan in the future.  (Yes, the monthly premiums can add up and here is a chart showing how your penalty costs can increase over time: 2016 Medicare Part D Late-Enrollment Premium Penalties will increase by 3%)



But what if taking financial risks is not an option to you?

People with more complex medication or healthcare needs must spend more time ensuring that their specific needs are covered.  For example, if you have a particular plan in mind (such as a local Medicare Advantage HMO that is provided by the large university or hospital system in your area), then you can review all of the coverage details we have online and then call the plan to learn whether their healthcare providers are included in the Medicare Advantage plan's network.

So where are these Medicare Advantage plans? To see all the Medicare Advantage plans in your Service Area (ZIP Code or County) with drug coverage (MAPDs) or without drug coverage (MAs) you can start on our homepage (Q1Medicare.com) and see the box that is entitled "Review 201x Medicare Advantage Plans" with a listing of state abbreviations.; For example, if you live in the Commonwealth of Pennsylvania, choose "PA", you will be taken to an overview of all counties in Pennsylvania. You can choose your County name ("Allegheny"). Then enter your ZIP Code to narrow the search ("15223"). You will then see a list of all Medicare Advantage plans in this area:  Medicare Advantage plans in ZIP 15223

Looking for the stand-alone Medicare Part D plans (PDPs) in your area? To get started, you can begin on our homepage (Q1Medicare.com) and see the box that is entitled "Review 201x Medicare Part D Plans" with a listing of state abbreviations for stand-alone Medicare Part D prescription drug plans.  For example, if you live in the Commonwealth of Virginia, choose "VA", you will be taken to an overview of all Medicare Part D prescription drug plans in Virginia:  All Medicare Part D plans in Virginia



So do I really need to enroll into a Medicare Part D prescription drug plan?

What if I currently don't take any medication and don't need prescription coverage? Medicare Part D is a voluntary program - with an incentive to enroll when you are first eligible for Medicare (the late-enrollment penalty). As some people who use no prescriptions note: "Medicare Part D is simply insurance against future uncertainty - like car or home insurance". The downside to not enrolling is that if you do not enroll when you are first eligible, you may be subject to a life-time Late-Enrollment Premium Penalty when you decide later to enroll in a Medicare Part D plan.


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.