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What is the best way to choose a Medicare Part D plan?

Category: Choosing a Medicare Plan
Updated: Aug, 31 2022

The simple answer is:  Choose a Medicare Part D (PDP) or Medicare Advantage (MA or MAPD) plan that provides the most cost-effective coverage for your medication and healthcare needs.

The more complicated answer is that each person will choose their Medicare drug plan for different reasons and there is no one "right" way to choose a Medicare Part D or Medicare Advantage plan.

The Centers for Medicare and Medicaid Services (1-800-Medicare) suggest that you look at the factors of Coverage, Cost, and Convenience when choosing a Medicare plan and to these criteria we also add that you should probably consider the Company and your level of Comfort.
  • Coverage

    • Are your prescription medications covered by this plan?
    • Are there low-costing generic alternatives for your brand-name drugs?
    • Can you work with this plan to get a formulary exception should you need a medication that is not covered on the existing formulary?
    • How large (generous) is the Part D plan's formulary or drug list?
    • What formulary price-tiers apply to your medications (for example, $30 co-pay or 33% of retail)?
    • What health coverage or supplemental benefits does the Medicare Advantage plan offer beyond basic Medicare Part A and Part B coverage?
    • What is the Medicare Advantage plan's maximum out-of-pocket limit (MOOP)?
    • Are there any additional coverage benefits offered by the plan?

  • Cost

    • What are the monthly plan premiums?
    • Does the Medicare Part D plan or Medicare Advantage plan have an initial deductible?
    • Are there any drug tiers excluded from the deductible that would provide immediate coverage?
    • 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 network pharmacy or an in-network health care provider or specialist? (Note: most Medicare Part D plans now have a pharmacy network of 50,000 to over 65,000+ pharmacies.)
    • Is your favorite pharmacy a preferred or standard network pharmacy?  (Your Part D drug costs can vary widely between preferred and standard network pharmacies.)
    • Does the Medicare Advantage plan have a restricted healthcare network (such as an HMO)?
    • Do your doctors (or local hospitals) accept this Medicare Advantage plan?
    • How easy is it to work with this Medicare Part D plan or Medicare Advantage plan when it comes to asking for Prior Authorization or exceptions to utilization management restrictions?

  • 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 company have an acceptable Medicare quality star rating?

  • Comfort

    • Are you comfortable with your current Medicare Part D plan or Medicare Advantage plan?
    • If you could find a more affordable Medicare plan, would you rather spend a few extra dollars per month because you have an idea how your current Medicare plan operates - and your plan costs are predictable - and you know that you can work with the plan?
    • Pro Tip:  If you are suggesting that your parents or friends change Medicare plan coverage based on pure economics, be sure to understand your parent's (or friends') level of comfort with their existing plan (doctors, pharmacists, specialists) - before persuading them to change Medicare plans.

      Still looking for more? Here are some general tips specifically for Medicare Part D prescription drug plan selection: Choosing a Plan: The Basics
Need a place to begin your search for a Medicare Part D or Medicare Advantage plan?

You can learn more about Medicare Part D plans in one of our top-10 Frequently Asked Question "What is a Medicare Part D plan": https://Q1FAQ.com/586.html

You can also start on our homepage (Q1Medicare.com) and see the box that is entitled "Review 202X 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:  https://PDP-Finder.com/VAOn this page, you can see the name of the Medicare Part D plans, the monthly premium, the initial deductible, and the co-payment rate for the different drug tiers.

If you are looking for a Medicare Advantage plan (with Medicare Part A, Medicare Part B, and possibly Medicare Part D coverage), you can start on the Q1Medicare homepage and choose the right-box entitled "Find a 201X Medicare Advantage Plan".  You can then enter your Zip Code or choose the state and county to see the Medicare Advantage plans available in your chosen Service Area.  (Medicare Part D plans are available state-wide, Medicare Advantage plans are offered on a ZIP Code or county area or partial-county area.)

Browsing a plan's formulary or drug list

If you wish to see the medications covered by this Medicare Part D plan, you can click on the "Browse Formulary" link on the right side of the chart to use our https://Formulary-Browser.com.  You can also click on the icons under the plan names for more plan details and plan contact information.

An example of using the Formulary Browser

Here is an example link to the first page of the Humana Walmart Value Rx Plan formulary in Virginia:
https://q1medicare.com/PartD-BrowseMedicarePartDPlanFormulary.php?stateReg=07VA &contractId=S5884&planId=186

(Important: when browsing a plan formulary or other healthcare coverage information, be sure you are looking at formulary or Medicare plan information for the current enrollment year - the plan year should be printed on the plan documents or shown on the computer screen.)

From this Humana Walmart Rx Plan example link, you can see the medication names and packaging information, drug tier number, tier description, cost-sharing and usage management restrictions (if any).  Using our Formulary Browser, you can always change the name of the Medicare Part D plan and state to browse other formularies.

Using the Q1Rx Drug Finder tool to see how all plans in your area cover a particular drug

You can also click on the icon after the drug name and you can see all of the Medicare Part D plans in Virginia that also cover this same medication and at what cost.  (This is our Drug Finder tool (found at Q1Rx.com) and you can change the prescription name to whatever you wish.)

An example of the Q1Medicare Medicare Advantage plan finder

As an example, here are the Medicare Advantage plans available in Fairfax County, Virginia:
https://q1medicare.com/PartD-SearchMA-MedicarePartDPlanFinder.php?state=VA&countyCode=51059 &showCounty=Fairfax

Again, you can see the basic coverage details of all these Medicare Advantage plans in the list, along with Medicare Part D prescription drug coverage details, if included on the plan (or MAPD).  The icon below the Medicare Advantage plan name that looks like a small stack of paper will show all of the coverage details for a specific Medicare Advantage plan.

Still need more help with specific issues?  Browse our Frequently Asked Questions

If you have specific questions, you can always browse our FAQ section found here:  https://q1medicare.com/FAQ.php

We have the Medicare & You Handbook online with additional information

We also have the CMS Medicare & You Handbook online, alone with our supplemental notes and information:  https://q1medicare.com/PartD-MedicareAndYouCMSGuideToMedicare.php

When you need to speak with someone about your plan options or are ready to enroll . . .

If you feel lost or overwhelmed along the way, you can always contact Medicare directly at 1-800-633-4227 (1-800-Medicare), select the prescription drug option, and then choose the option to speak with a Medicare representative or say "representative" during the menu options.

Once connected, you can explain your situation to a Medicare representative and ask them to help you find a Medicare Advantage plan or Medicare Part D prescription drug plan that most economically covers your health and medication needs - or you can ask specific questions about a particular Medicare plan or the Medicare Part D program in general.

If you find a suitable Medicare Advantage plan or Medicare Part D plan and are eligible to enroll into the plan, the Medicare representative can process your enrollment into your chosen Medicare plan directly over the telephone - and the process only takes a few minutes.  A Medicare representative is not compensated for a Medicare plan enrollment and provides you with an unbiased view of all available Medicare Part D plans or Medicare Advantage plans.

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Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • 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.