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.
- Are your prescription medications covered by this
- Are there low-costing generic alternatives for your brand-name drugs?
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?
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?
- 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?
there any supplemental prescription coverage in the Donut Hole?
Need a place to begin your search for a Medicare Part D or Medicare Advantage plan?
- 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
- 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?
- 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
- Does the company have an acceptable Medicare quality star rating?
- 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
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/VA.
On 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
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:
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:
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.