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Pre-2010 Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)

Pre-2010 Medicare.gov - Tutorial - Select up to three plans to compare
***Archive: Below is the Pre-2010 Medicare.gov Tutorial***

If you wish to compare one Medicare Part D plan to another, the Medicare.gov website allows you to select three Medicare Part D plans to analyze in more detail. "Check" three of the plans and then click on "Compare" and the site will lay the three plans side-by-side.

Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)
Note: if you wish to compare three other plans, you must use the "Reset Checkboxes" button. If you simply uncheck the boxes, the system will still think that you have made your three choices. (This is bug and will probably be fixed soon.)

Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)

Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)
In our example, we chose a RxAmerica plan with no ($0) initial deductible, a RxAmerica plan with an initial deductible ($275), and a Part D plan from Community CCRx with an initial deductible ($275).

Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)
Keep in mind that the prescription cost data is being updated continually. So if you are following along with our example, you may not get exactly the same results.

We have also found that at times, the prescription retail cost data is wrong!

In one example the drug ETODOLAC TAB 500MG was shown as having a retail cost of $22.58, $24.70 and for the third plan $77.34! When we went to the plan's website and checked the drug in their rx calculator, it showed a price of $27.35. This can greatly skew the accuracy of your plan comparison. So, if you see a retail cost that seems drastically inconsistent with the other plans, you may wish to save your drug list and try your comparison again in a few days or a week to compare the accuracy.

When we compare the three Part D plans, we see that the Medicare.gov site breaks the entire form into many sections (see graphic below):

"Plan Ratings"
One of interesting feature that Medicare.gov provides is a Plan Rating based on a number of factors. The ratings come from a sampling of experiences and, like any sample of events, these Medicare findings may or may not correspond with your own experiences.

"Cost Summary"
We consider the Total Annual Drug Plan Cost to be one of the most important factors that folks should consider when choosing a Medicare Part D plan. This figure is the total amount that you can be expected to pay for the whole year, including monthly premiums and deductibles.

"Your Monthly Drug Cost before you have met your deductible"
This first coverage area shows what will happen as you begin to use your plan in 2008. Note that the first plan does not have an initial deductible so this area does not apply and the fields are filed with "N/A" for Not Applicable.

Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)

One of the interesting things that people will note from the beginning is that the initial deductible for two of the plans is $275, but the total Monthly cost for this first coverage area is way over this amount. There are two reasons for this Total Cost figure that is over the initial deductible value: (1) there are some medications that are on the My Drug List that are not included in the Part D plan formularies — and since they are not in the formulary the cost is not included toward the initial deductibles or the Initial Coverage Limit (before the doughnut hole). (2) The Medicare.gov website is not programmed to break coverage periods within a month (This is a bug and may be fixed, however it was the same in 2007). In our Q1Medicare.com Doughnut Hole Calculator, we break the initial deductible into smaller portions and allow a person to go through multiple phases of coverage in a single month. In other words, in this example beneficiary would meet their initial deductible in about 25 days with the Community CCRx plan — well before the end of the first month $275/(Retail Drug Costs — Non-Formulary Drug Costs). If the RxAmerica plan is selected, the example beneficiary would spend $233.08 on covered drug in the first month and an additional $108.57 on non covered drugs, thus reaching the initial deductible $275 in the second month of coverage.

"Your Monthly Drug Cost after you have met your deductible but before your total drug costs reach the Initial Coverage Limit [beginning of the Doughnut Hole]"
The next coverage phase takes our example up to the Doughnut Hole. In 2008, the Doughnut Hole is reached when the total retail cost of covered prescription drugs reaches $2,510. This beneficiary should reach the doughnut hole in $2,510/$233.08 = 10.76 months or late November with the RxAmerica plans. This same beneficiary would reach the doughnut hole in 7.53 months or mid-August with Community CCRx plan (because more medications are included in the total covered retail costs). Our example beneficiary would not leave the doughnut hole or coverage gap in 2008 — no matter which of the three Part D plans would be chosen.

"Your Monthly Drug Costs after your total drug costs reach the initial coverage limit but before your total out of pocket expense equals $4,050.00" [What you pay in the Doughnut Hole or Coverage Gap]
This Part D coverage area shows the user what they will be paying in the Coverage Gap or Doughnut Hole. This is the full retail cost of the medications (less any discounts negotiated by your Part D provider). (See graphic below.)

Your Monthly Drug Costs after your total out of pocket expenses equal $4,050.00. [After your leave the Doughnut Hole and enter catastrophic portion of your Part D coverage].

When you reach the catastrophic portion of your Part D coverage, your covered prescription drug costs full dramatically. Please note that non-covered medications are still shown as retail cost because they are outside of the Part D plan. In order to exit the Doughnut Hole and enter the 2008 catastrophic portion of Medicare Part D coverage, the Medicare Part D beneficiary will have covered retail prescription costs of over $477 per month.

Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)

The next section shows the number of pharmacies located in your ZIP Code area and whether the Medicare Part D plan offers a mail order service.

Nearing the bottom of the page is the "Drug Coverage Information" which shows the medications from the My Drug List that are covered under the Part D plan formularies. Notice also that some medications are subject to usage management such as prior authorization, step therapy or quantity limits. (See graphic below.)

Finally, the last section on the page shows the "Full Cost of Drugs" or the Part D plan’s negotiated retail cost which is the same as the cost shown above in the Doughnut Hole coverage phase.

Medicare.gov - Tutorial - Compare Plans in Your List (Plan Details)

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.