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
- 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
supplemental 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)?
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:
- Should enroll in a Medicare plan with the lowest priced monthly premium just to avoid any future
late-enrollment premium penalty or
- 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
- 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:
2023 Medicare Part D Late-Enrollment Penalty rate will decrease - but maximum penalties can reach up to $783 for the year.)
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.