Medicare.gov - Tutorial - Additional Medicare Plan Details
Once a Medicare Part D drug plan is found, the user of the Medicare.gov Plan Finder can learn more about the Medicare plan details by clicking on the plan name in the plan overview.
The bottom portion of the page shows a summary of medications and a bar chart illustrating the coverage phases of this Medicare Part D plan. In our example, we used a very expensive medication and you can see the retail cost of all the medications in the first column. In the next column of the chart, we see the prescription drug costs during the initial deductible phase. Since the retail costs are so high, we actually go through the initial deductible, initial coverage phase and the doughnut hole in the first month. The second month begins the catastrophic portion of the Medicare Part D plan and continues through the end of the year.
If the option is chosen to "Add More Drugs", you will be returned to the drug search form. When you have completed adding more drugs, you will again be asked about your pharmacy preferences and then arrive back at the Medicare plan overview or summary page.
Now back to learning more about the plans. Medicare suggests that you choose a Medicare Part D plan based on the 3 "C’s": Cost, Coverage, and Convenience. We would add to this a fourth "C" that is important to many people: "Company". Everyone should ensure that their medications are covered (or at least their more expensive medications). Some people are looking at only cost — which Medicare plan will cost the least across the whole year. Some people will pay more annually for a Medicare Part D plan just to have no initial deductible ($0 deductible or first dollar coverage). Some people will pay more for their medications just to have a lower monthly premium. Some people only want the convenience of knowing that their local neighborhood pharmacy will accept their Medicare Part D plan so that they will not need to visit a chain pharmacy. Some people choose a Medicare Part D plan based on the underlying company — they select ABC Insurance Company, because they have always worked well with ABC Insurance Company.
Bottom Line: Everyone has a way to select a Medicare Part D prescription drug plan that is right for them. We usually suggest that you choose the Medicare Part D plan or Medicare Advantage plan that provides the most affordable health and prescription coverage and best service throughout the whole year.
Notice the Usage Management Restrictions
In the graphic above, you can see the medications are sorted by formulary or drug list tiers. Usually the higher tiers are reserved for more expensive or exotic medications, and this is true with this plan's Tier 5. Several of the medications also have certain formulary restrictions including Prior Authorization (where you need to receive written approval from the Medicare plan before filling a prescription, usually your prescribing doctor will help you with the Prior Authorization form) and Quantity Limits (you are allowed coverage for a certain amount of your prescription each month or other time limit). No medication in this example falls into having Step Therapy (you are asked to try another, less expensive medication before being allowed to use this prescription.).