How to choose the best Medicare prescription drug plan. (Can the free Medicare Advantage prescription drug plans actually cost more?)
The majority of Medicare Advantage plans include a prescription drug plan. Medicare Supplement plans do not include a prescription plan. A separate prescription drug plan (called Medicare Part D) is advisable to go along with a Medicare Supplement plan. The drug plan included with a Medicare Advantage plan is usually similar to the coverage offered with a Medicare Part D prescription plan.
The total cost of a drug plan includes the out-of-pocket cost of the medication and the monthly drug plan premium. The total cost of the prescription drug plans frequently included with a Medicare Advantage plan is sometimes higher and sometimes lower than the total cost of a Medicare Part D prescription plan that is purchased separately. This depends on your particular set of medications.
The government Medicare website has an good method (if somewhat laborious) for entering one’s own medications and then showing which plans are available that have the least total annual cost (out of pocket cost of medication plus premium costs)
Details for using Medicare.gov website for Comparing Drug Plan Costs
A few caveats:
The prescription drug plan that comes with a particular Medicare Advantage plan cannot be substituted for another drug plan. The Medicare website calculates the annual total cost for a given set of medications for comparison purposes.
Any of the “stand alone” drug prescription plans (Medicare Part D) available to those with traditional Medicare can be changed once a year for another Medicare Part D plan. This can be done during the annual fall open enrollment period, October 15th – Dec 7th. If one’s medication list changes or the plan changes, this allows those with Medicare Part D plans to find a new plan that may have lower total costs. Medicare Advantage plan participants cannot change drug plans without changing to a different Medicare Advantage plan.
The total annual cost calculation provided by the Medicare website is for the remainder of the year. However, during the Oct 15- Dec 7 annual fall open enrollment period, the annual total cost of the individual Part D drug plans on the Medicare website can be seen for the entire next year or for the remainder of the current year.
All Medicare drug plans are offered by private insurers and are heavily subsidized by the government. The private insurance companies offering these plans can vary in important details of the plan, including the cost of individual medications. The cost of medications vary quite substantially between plans, so in order to determine the projected annual cost of a drug plan, your individual medications must be entered. Both Medicare Plan D drug plans and the drug plans included in Medicare Advantage plans typically have substantial out-of-pocket costs.
A separate Medicare Plan D prescription plan can not be purchased for use with a Medicare Advantage plan. Obtaining a Plan D prescription plan can lead to being disenrolled from a Medicare Advantage plan.
Medicare Part D drug plans can be used with a Medicare Supplement plan and have a monthly premium. Medicare Advantage drug plans frequently do not have a monthly premium.
Some helpful health insurance agents may ask you to bring in your list of medications so they can help with using the Medicare.gov site to find the lowest cost plan for your list of medications. It is possible to use the Medicare.gov website yourself and it provides a wealth of information. The instructions for doing so are as follows:
Details of how to use the government website for assessing drug prescription plans.
Detailed instructions:
Go to: https://www.medicare.gov
Scroll down & Click on box labeled “Find health & drug plans”
(If pop-up box shows, can close box by clicking “x” in top right corner.)
“Continue without logging on” (on right side of page). Select appropriate year.
Add zip code
Plan Type: Select Drug Plan (Part D) Click “Apply” Then click “Start”
Question: Do you get help with your costs from one of these programs?
Answer: “I don’t get help from any of these programs” or whatever is appropriate. Click “Next”
Question: Do you want to see your drug costs when you compare plans?
Answer: Yes. (The drug plans have widely different prices for the same drug.) Click “Next”
Add Prescription Drugs: (Type in medications)
Click “Add to my drug list” for each drug
Scroll down and click on “Done Adding Drugs” when finished.
Choose Pharmacies (Can add multiple pharmacies. Different pharmacies have different costs for medications even for the same Medicare Drug Plan.)
Select “Done” at bottom right of the window when all pharmacies selected.
Look at results. There will be 3 pages of plans in the order of total plan cost (monthly premiums and drug costs) from the least expensive to the most expensive.
The YEARLY DRUG & PREMIUM COST of each plan is listed. This is the total cost of the year for the plan taking into account your drugs, the plan’s deductible, and monthly premium using the least expensive pharmacy on your list.
Click “Plan Details” of each plan of interest and scroll down to allow the different cost of the pharmacies to be seen as well as the individual cost of the drugs. Be sure to check on the total cost of the pharmacy (or mail order option) you actually plan to use. There can be a major difference in overall yearly costs depending on which pharmacy is selected for the same medications and plan.
NOTE: The yearly results are for the remainder of the year. However, during the Oct 15- Dec 7 annual open enrollment period, the cost information is available for the entire next year or for the remainder of current year.
The information for the total cost next year is actually available beginning October 1st, but there is less accuracy on drug costs in the system, so some erroneous information is more likely. Waiting unit October 15th is better, and there may even be some further improvement in accuracy by November 1st.
A stand-alone drug prescription plan (Medicare Part D) can be changed every year during the Medicare fall enrollment period (Dec 15th-Dec 7) without penalty for changing plans. If your list of medications changes substantially, a different drug prescription plan may offer a significantly lower total cost for the year. Similarly, your plan each year can change the premium, deductible, and cost of the drugs which also will change the total cost of the plan.
How to change Medicare Part D plans online:
During an eligible enrollment period for Medicare Part D, you can enroll in a new prescription drug plan online. You don’t need to cancel your old plan because your old coverage stops once your new Medicare drug plan begins. Your new plan should send you a letter telling when your new drug coverage starts. It is advisable to switch plans as soon as you can within your enrollment period. This may help ensure that you get your membership card for your new plan by the time your new coverage begin. (Also, don’t change plans with a company that initiates the contact with you online, since that may be a scam. Only deal with companies that you initiate the contact with the website.)
Related topic: Why a Medicare Supplement Plan G is frequently a better choice than a Medicare Advantage plan.
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Drug plans with Medicare Advantage plans:
With any given Medicare Advantage plan, there is usually only one predefined drug prescription plan that cannot be changed. You only get these drug plans by looking at the particular Medicare Advantage plan that goes with each Medicare Advantage plan.
To see the costs for prescription plans with a Medicare Advantage plan:
For the first Question (“What type of 2023 Medicare coverage do you want?”) under the “Detailed Instructions” on this webpage, answer “Medicare Advantage Plan”.
Medicare Health Plans with Drug Coverage (The drug plans with HMO, PPO written by them are the drug plans included with a Medicare Advantage plan.)
