10/19/2018 By Agent Ken CobbBy Agent Ken Cobb
If you are losing your current Medicare plan with Blue Cross, Medica or Health Partners, you may need to choose new drug coverage (as well as new medical insurance) for the coming year. If you choose an Advantage plan, your prescription coverage will likely be bundled with your medical benefits; while if you choose a Medigap plan, you will need to buy a separate Part D plan to cover your medications. Either way, it’s important to carefully consider what prescription drug coverage will best suit your needs.
If you are currently taking prescriptions, it is wise to start by putting all your current drugs into Medicare.gov. This will allow you to compare how different Advantage plans and/or Part D prescription drug plans will cover your medications. If you are working with an agent, you can ask your agent to do this for you.
It might seem easier to just compare the copays and deductible for various drug plans and make a decision that way, but here’s why entering your drug list on Medicare.gov to compare different plans is so important:
1. Different plans might place your drugs in different tiers. Every plan has a “formulary”, which is a list of drugs covered by the plan. Just because your current plan considers a drug you take to be in “tier 1” doesn’t mean another plan might not classify it as a “tier 2” or “tier 3”. So simply comparing different plans’ copays for each tier is not sufficient.
2. Some plans might not cover all your medications at all. You might be taking a particular drug that is covered by some plans and not by others. If this is the case, knowing this ahead of time is very important in choosing your new drug coverage.
3. Some plans might impose quantity limits, require prior authorization or “step therapy” for a certain drug. (“Step therapy” means that the carrier will want confirmation that you have tried other, less expensive medications before they pay for a particular drug.) While it’s possible that every plan you compare might have the same restrictions on one or more of your drugs, it’s also possible that some plans might be more liberal than others in your situation. Either way, this is something you want to know up front, rather than it being a surprise later.
4. Your pharmacy might not be covered by all plans. Every plan has a list of pharmacies that it considers “in network”. If you fill your drugs at an “out of network” pharmacy, you will have to pay the full retail cost of your drugs in most cases. If you find that your pharmacy is not “in network” with some of the plans you are considering, you will have to decide whether you want to change pharmacies or if you prefer to choose a plan that covers the pharmacy you already use.
5. Different plans might cover your pharmacy differently. Many plans have a list of “preferred pharmacies” and a second list of “standard pharmacies”. While you will be covered either way, if you use a plan’s preferred pharmacy, your copays may be significantly lower. Since your pharmacy might be “preferred” on one plan and “standard” on another plan, knowing this up front will help you make a good decision.
Once you enter all your drugs into Medicare.gov, this website will then show you the following details:
When entering your drug list on Medicare.gov, it is important to carefully make sure you a) enter the right drug (as there are many similar names), b) you select the correct version, c) you choose the right dosage and d) you input the correct quantity and frequency of fill. All of these must be entered accurately or else the comparison information that Medicare.gov provides you may not be reliable.
As a general rule, you will be locked in to the same drug plan for a full year. So what if your doctor changes your medications in the middle of the year? Obviously, Medicare.gov cannot anticipate what future changes might happen. If you are already aware that your doctor might switch your medications, Medicare.gov can be used to run “what if” scenarios. But, otherwise, the best that you can do is to compare plans based on the prescriptions you currently take, with the hope that any changes over the course of the year won’t cause major problems.
While Medicare.gov is a very important and useful tool, it’s my opinion that some of the comparison information it provides can be confusing to follow and understand. For this reason, many of my clients bring their drug lists in when we meet so that I can help input their information and explain the report that Medicare.gov provides them. This is a valuable service you can enjoy free of any additional charge when you get help from a trusted local agent.
More Medicare Resources:
View more info on our health insurance page >
Three Options if you are losing your Medicare plan >
How much does it cost to get help from a Medicare agent? >
Six quick questions to consider when choosing new Medicare coverage >
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About the Author
Agent Ken Cobb
Ken is the owner and principal agent at Pine Country Insurance in Bemidji. Active in the insurance industry since 2000,Ken uses his years of personal insurance knowledge and experience to assist clients in customizing insurance coverage to fit their needs. Ken considers himself a "farmer" rather than a "hunter"; rather than focusing on writing a lot of new policies as quickly as possible, he works on cultivating long term relationships based on trust with his clients. When writing new policies and meeting for annual reviews, Ken spends time with his clients explaining and helping them understand their insurance, and he is also pleased to share his knowledge with his blogging audience as well.
Ken Cobb is owner of Pine Country Insurance and has been active in the insurance industry for over 15 years. Meet Ken.
Coverage descriptions found in this blog are summaries provided for general educational purposes and cannot fully detail the terms, conditions, limitations or exclusions of a specific insurance policy. Please read your policy carefully.