Your goal in choosing a Medicare Part D prescription drug plan is to select a plan that:
But Part D plans can change their costs and coverage every year, just as the prescription drugs you take can change. And there are a lot of options out there, so consider this when selecting a plan.
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Depending on your state, you may have from 15 to 24 stand-alone Part D plans to choose from in 2024, according to KFF, formerly the Kaiser Family Foundation. Comparing that many plans can be overwhelming, but several tools and resources can help you assess the right plan for your needs.
Here’s how to determine your best Part D plan when you first sign up or during Medicare’s annual open enrollment period from Oct. 15 to Dec. 7 for coverage starting January 1.
Tip: Don’t look just at a plan’s premiums. Also compare the coverage and total costs for your medications. Your answers to these questions will help narrow the field.
Using the Medicare Plan Finder, make sure the drugs you take are part of a plan’s formulary, what insurers call a list of covered drugs. Otherwise, you’ll pay full price for drugs that your plan won’t cover.
After you’ve entered all of your medications, you can see how much you’ll pay for them with each plan. Two plans that cover your medicines may have very different costs, depending on the copayments they charge for your drugs.
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To find potential costs in the Plan Finder, type in your ZIP code, choose Medicare drug plan (Part D) and type in your drugs, dosages and the pharmacies you use. You can sort plans by Lowest drug + premium cost. Click on Plan Details to see how much you would pay for your medications under each plan. You’ll also see an estimate of your drug costs by month.
Most Part D plans have four or five pricing tiers, starting with the lowest copayments:
That’s not how you’ll see the information presented in the Plan Finder, but this can help you understand why you might see different prices for the same prescription when you compare plans in your area.
You may uncover other information by going to the website of a plan you’re interested in, including how the plan regulates your medicines. You’ll want to know whether a plan imposes any restrictions, such as requiring your doctor to complete prior authorization forms before a drug will be covered or using a lower-cost drug before the plan will cover a similar but more expensive medication. That’s known as step therapy.
Other options: Call 800-MEDICARE (800-633-4227) for help, or work with representatives from your State Health Insurance Assistance Program (SHIP).
ARTICLE CONTINUES AFTER ADVERTISEMENTThis can be just as important in determining the price you pay for your prescriptions as the plan’s formulary. Many Part D plans have preferred pharmacies that charge lower copayments than other pharmacies in the plan’s network.
You can enter up to five pharmacies in the Plan Finder to determine if they’re preferred in-network pharmacies, standard in-network pharmacies that have higher copayments, or not in a plan’s network. Click view your pharmacies to see what your out-of-pocket costs would be for your medications at different pharmacies.
One example: If you use a preferred in-network pharmacy, the least expensive Part D plan in one area could charge $0 for a 30-day supply of 5 milligrams of amlodipine, the generic equivalent of the blood pressure medication Norvasc. The same prescription could be more than $40 per year at another in-network pharmacy that’s not on the plan’s preferred list and more than $600 at a nearby out-of-network pharmacy.
Several factors can affect the total cost for a Part D plan during the year, including premiums, deductibles and copayments for your medications. Plans were allowed to charge a deductible of up to $505 in 2023, and that will rise to $545 in 2024, while some plans have no deductible.
