Selecting A Medicare Prescription Drug Plan

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Selecting a Medicare prescription drug plan has become increasing more complex. These tips are what you need to guide you with selecting the best Part D prescription drug plan for you, saving money and inconvenience.

The only way to reliably know what is the cheapest and best plan for a client is to review the plan on http://www.medicare.gov.

You want to make sure all of your prescriptions are on a plan’s formulary. Get a list of all of your prescriptions, including the dosage and quantity taken each month. You also need to know your preferred pharmacy. In addition, explore prescriptions you might start taking in the next year.

If you have an important medication and you are having trouble finding a plan where the prescription is on its formulary, use the formulary finder at http://www.medicare.gov instead of the plan finder. Some prescriptions are not covered by Medicare at all.

In addition, some plans have restrictions on prescriptions. There are three types of restrictions: prior authorization, step-therapy (must try other drugs before the client’s preferred drug), and quantity limits. Generally, you will want to avoid any plan that has these restrictions, particularly plans that require prior authorization or step-therapy, if there are plans available without these restrictions.

If you found a plan that is perfect for you client except for the quantity limits on a certain medication, see if you can play with the dosage to make the quantity limit work. If a plan has a limit of thirty and you takes sixty 50-mg pills, you should check with the doctor to see if the doctor will allow you to take thirty 100-mg pills and split them. This could save you thousands of dollars.

For initial enrollment, you must enroll in Medicare Part D at the earliest opportunity or face a penalty of 1 percent of the average Part D premium for each month you should have enrolled but did not. Each year, there is usually one minimal prescription drug plan that a client can enroll in to prevent a penalty and have some prescription insurance in case he or she needs it.

This penalty is paid for the rest of your life. For example, if a person waited three years to enroll, he or she would pay a penalty of 36 percent of the base premium, which is $31.17 in 2013. Thus, in 2013, this individual would pay an $11.22 penalty in addition to his or her premium each month.

A person can delay enrollment in a Part D plan without penalty until 63 days after he or she leaves an employer group plan or otherwise involuntarily loses coverage from a creditable plan. Acreditable plan is one that is at least as good as the basic benefit. The plan is required to send out a notice each year to its subscribers before annual enrollment, confirming that the plan remains creditable. Of course, an individual with a creditable plan could choose to leave that creditable plan and join a Medicare Drug Plan during annual enrollment each year.

If you are receiving prescriptions from a retirement plan that does not provide creditable prescription drug coverage, run a cost-benefit calculation to see if it makes sense to switch to a prescription drug plan and take the penalty to get better prescription drug coverage and prevent larger penalties in the future.

If you are married, the right plan for your spouse might be very different than the right plan for you. Everyone is treated as an individual when it comes to Medicare plans. This is often a hard concept to understand if you are used to having the same coverage through an employer plan.

Part D plans are one-year relationships. You and the plan renegotiate this relationship every year because the plan could make significant changes or your prescription needs could change. You need to actively decide whether or not to get together again for another year. Currently, this is done between October 15 and December 7 each year.

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