How to Shop for a PDP for 2019

Medicare Part D shopping

Shopping every year for the best Medicare Part D plan is a must to keep your costs under control

Medicare Part D prescription drug coverage is offered by individual insurance companies, and not through Medicare itself. Sometimes they’re called PDPs.  Every year, these plans change the rules – premiums, drugs covered on the formulary, pharmacy networks all can change.  You really DO need to shop every year if you have a Medicare Part D PDP, or you may be paying too much! With that in mind, it is important to know what you should be looking for prior to committing to a Part D plan this AEP.

How to Shop for the Right Medicare Part D Drug Plan

Based on where you live, there could be a number of different Medicare Part D drug plans to choose from – and these may have different coverage and premiums. So, it is important that you do a bit of homework before you make a commitment on the plan that is best for you and your specific needs.

While this may take some time, in the long run, shopping for the right Part D plan could end up saving you hundreds – or even thousands – in out-of-pocket expenses each year.

So, what are some of the key items to look for when searching for the best Medicare Part D plan? The list should ideally include the following:

Annual Drug Costs

One of the first things that you should do is take a look at what your medications cost you each year. In reviewing Medicare Part D plans online – and based on your drug list and the pharmacy that you choose – you can see the average cost for plan members.

When going through this Plan D research process, you can click on a Part D plan name, which will then provide you with access to various details about the plan, such as the tier of coverage that your medications fall in, as well as how much they will cost you each month of the year (and at each of the pharmacies or retail establishments that you choose). Be sure that you make careful note here, as the price of the very same medication can differ – sometimes by quite a bit – at different pharmacies.

Coverage Rules

Another key area to review is the coverage rules. Here, make sure that you determine whether or not plans have various rules with regard to certain medications. In this area, there will typically be three main headings, including:

  • Prior authorization – With some Medicare Part D plans, prior authorization may be required. For instance, some plans only approve prescriptions under certain types of medical circumstances whereby the plan enrollee and / or their doctor will need to supply certain information before the drug will be approved for coverage.
  • Quantity limits – The prescription drug plan may also have certain limitations on the quantity that an enrollee may obtain at one time. In some cases, this may be 30-day’s worth, in others it may be 90.
  • Step therapy – With step therapy, a drug plan may require that the insured try another drug first (such as a generic) before the plan will cover the preferred medication. (This is oftentimes a cost issue, as generics usually cost less than brand name options).

Medicare Part D Changes for the Upcoming Year

If you are currently enrolled in a Medicare Part D plan, then don’t t assume that your plan will remain the same from one year to the next!  Your Annual Notice of Change was mailed to you by October 30th, so check that stack of mail on your counter.  This came along with your plan’s Evidence of Coverage Notice, which outlines any changes that may be made for the upcoming year.

You don’t have to read all of it, but pay attention to a few sections.  It’ll tell you what your 2019 premiums will be, as well as any formulary changes.

As we move out of 2018 and into 2019, there are some changes that will likely be seen with regard to Medicare Part D prescription drug plans. These may include the following:

  • Changes in premium cost
  • Changes with deductibles and / or copayments
  • Revisions to medications that are (or are not) included on the plan’s formulary
    Changes to the pre-approval requirements for accessing medications
  • Limitations on the amount of medicine that may be received by plan enrollees
    Changes to doctors and / or pharmacies that may be used
  • Differences in payment dates

While such changes can affect anyone who is on the plan, they can be particularly impactful for those who have serious medical conditions – such as diabetes, cancer, Alzheimer’s disease, heart disease, or Parkinson’s disease – and who require numerous (and oftentimes costly) medications.

Need More Information on Choosing a Medicare Part D Plan?

If you need more information on choosing a Medicare Part D plan, you can find a lot of detail on Medicare’s website by visiting.  Click here to start your search, and have your prescription drugs ready so you can enter in your meds.   You can also contact a local Medicare insurance professional who can answer any questions that you may have.

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Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.