Why You Should Compare Medicare Part D Plans During Open Enrollment

Medicare Prescription

If you or someone you care about is enrolled in a Medicare Part D plan, it’s important to know about the Open Enrollment Period (Oct 15th through Dec 7th) and why you should do a comparison every year.

Medicare Part D insurance is the plan that helps pay for prescriptions for people who are eligible for Medicare.  The total cost to fill prescriptions consists of any plan deductible, monthly premiums, and any co-pays at the pharmacy.

Even if you are happy with your current plan, you should still do a comparison because the details of each plan can change each year.  If you take no action, your current plan will remain in effect.

Potential Yearly Changes

1. Deductibles

The 2013 deductible limit is $325, but plans are allowed to have a lower deductible or no deductible at all.  Your existing Part D plan may have changed their deductible for the upcoming year and might not be as competitive.

2. Co-pays at the Pharmacy

Each Part D plan has a unique relationship with each pharmacy.  The relationship between your plan and your favorite pharmacy might have changed.  If you want to stick with your pharmacy, there may be a less expensive plan. If you are concerned about costs, switching to a plan that has a preferred pharmacy in your area may also significantly lower your costs.

3. Monthly Premiums

Monthly premiums can go up, can even go down, or may not change at all for next year.  Keep in mind that the premium is only one part of the cost – and the cheapest premium may not be the least expensive way to go when adding in the deductible and co-pays.

4. Mail Order Options

Many plans offer a mail-order option that can help save you time and money.  Prescriptions are filled for 90-days at a lower cost and you save time by having them delivered to your door.  Your doctor’s office can help get you set-up with a mail order plan by faxing over your current prescriptions.

5. Your Prescription Needs

The least expensive Part D plan is based on who you are as a consumer.  If your prescription needs have changed since the last time you picked a plan, then sticking with your current plan may not be the best option.

How to Compare Medicare Part D Insurance Plans

1. Help is available online.

Medicare has a wonderful online tool to help you compare the plans in your area.

  • Go to Medicare.gov and click on the Find Health & Drug Plans box to use the online tool.
  • Find a list of your state’s available plans but only the Medicare online tool will add up all your costs – including co-pays on your specific prescriptions.

2. Help is available toll-free.

You can call Medicare at 1-800-633-4227 and speak with a Medicare representative.  They will enter your prescriptions and give you information about the plans in your area.  Representatives are available 24/7 but there could be longer wait times during key daytime hours.

3. Help is available from your caseworker or social worker.

If you or your loved one has a caseworker or social worker that visits them or is part of their living facility, that person should be able to help use the Medicare website to compare Part D plans.  You may need to be proactive in asking for this specific assistance.

4. Help is available in your community.

  • Call your local Area Agency on Aging to see if they offer Medicare Part D workshops or one-on-one counseling appointments at their site, or help by phone.  This nonprofit will offer unbiased information to help you make the best decision for your needs.
  • Check with your pharmacy to see if they offer plan comparison assistance at their locations.  Keep in mind that they may have a bias since some plans favor specific pharmacies.

When Comparing Keep in Mind . . .

  • There is no penalty for changing Part D plans during Open Enrollment each year.
  • Any changes in your Part D plan selection take effect on January 1st of the following year.
  • The cheapest premium may not be the cheapest plan overall.  A higher premium may have a $0 deductible and lower co-pays at the pharmacy – and be the lowest cost plan for you.
  • You might be able save a significant amount by switching plans and/or pharmacies.
  • If you are on a limited income, you may qualify for extra help to help pay for deductibles, premiums, and your co-pays.
  • If you’ve recently learned that you qualify for extra help, you can change Part D plans immediately even if it’s not during Open Enrollment.

Take this opportunity to compare your Medicare Part D plan for the upcoming year in order to get the most for your money.  Offer to help any loved ones do a comparison online or get help from their community resources.

What would you advise a friend or family member about Medicare Part D plans?  Have you used the online comparison before?  Leave a comment!

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13 Comments
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  1. Gayle McLaughlin

    Thank you for this article. I am a baby-boomer who just went on Medicare. I am overwhelmed with the choices and the ins and outs. I wish more people would write on this subject. Thanks again for your information.

    • Gayle – It is overwhelming! All the ‘moving parts’ of Medicare – putting together the 3 different pieces of the insurance puzzle – are complicated. The marketing of Medicare Supplement plans and Part D plans only adds to the confusion.

  2. Jeannie D'Amico

    I just enrolled in Medicare. I am very healthy and on NO medications.. is Part D good for me? I realize I can change during open enrollment next year, but I have to sign up for something before November 1 .

    • Jeannie – Please see a detailed answer below Gayle’s comment.

      I hope you call the Medicare number or try to find an in-person resource in your area to understand what plans are available in your community that work best for a healthy person. Area Agencies on Aging are non-biased groups that work with you on the options – but do not sell or benefit from you deciding to enroll in a specific plan.

      At the local AAA where I volunteer, we tell people to consider Part D like car insurance – do you find comfort in having it in place? We hope to never use car insurance – because that means something bad has happened. Medicare Part D Insurance plans are similar for the healthy person – you actually hope you never need it but it’s there just in case.

      In my state, the lowest premium is $15 per month. Should something happen that you need an short-term prescription, it’s in place. If you don’t use it at all, you are at minimum avoiding a penalty (which is assessed every single month you are enrolled in a Part D plan after you delay enrolling) and saving yourself that fine.

      You have a 7-month window when you turn 65 – 3 months before, the month of your birthday, and 3 months after. If you are in that window, coverage will begin on the 1st of the month after you enroll.

      If you are past that window, you can enroll each year during the annual Open Enrollment period between October 15th and December 7th – coverage will begin on January 1, 2013.

      You still have time to consider for 2013.

      • Jeannie D'Amico

        Cherie, thank you for all the information you were kind enough to passon. I got a low cost drug plan with humana. At least if something happened, God forbid, I would have that in place. I’m a bit of a procrastinator and so was under the gun to get coverage in the window, and couldn’t actually get an appointment with Area Agency on Aging, but they were very helpful on the phone. I don’t have any paperwork yet; hopefully I will get something in the mail soon…I think I am ok through November. Your message was very helpful in my decision making. I know my Mother did not sign up for part B (I think) or part D and she incurred heavy penalties! God bless you. Jeannie

  3. Gayle McLaughlin

    This is my personal opinion. You can get generics of most medications–if you would have to have a prescription. I would not spend your money on a plan. Generics are usually $4.-10.00 from any pharmacy. Then you could add a prescription plan next year.

    • Jeannie D'Amico

      Thank you, Gayle. I will just call Medicare to make sure there is no penalty for not having a plan in place. I don’t anticipate any major problems in the next year, and I know K-Mart and WalMart have the generic plans which are not too expensive. It is mind boggling to see how much mail you from insurance companies, etc in the months before (and after) you turn 65! I had so much that I need to buy a new shredder!!! Blessings!

      • Gayle McLaughlin

        I so understand! One is bombarded with all the paper and the different insurances and it is so hard to know what one is right!

    • Gayle – I know it’s tempting to stick with generics that are low-priced and not add on the additional cost of a Part D Plan. However, by not signing up for a plan when you become eligible for Medicare, you will incur a penalty once you do need a plan in place. That penalty is assessed every month by your Part D plan for each year you sign-up for a Part D plan.

      The penalty is calculated at 1% of your state’s average monthly premium multiplied by the number of months not enrolled. (Note: If you have “creditable coverage” equal to the coverage of a Part D plan during that time, you will not have a penalty but will have to provide documentation to prove it. This coverage might be from an employer’s retiree plan or a spouse’s health care plan.)

      For example: A wife came in because she was turning 65 and wanted a Part D plan in place. The husband did not sign up for a plan 2 years ago (when he turned 65) because his prescriptions only cost $25 per month out of pocket without a Part D plan. He figured the self-pay cost was better than paying for insurance, a possible deductible, and any co-pays.

      When we ran a comparison on the website for 2013 plans, we found a Part D plan in the area for $27 premium and $0 co-pays on generics at his pharmacy of choice. This would actually cost him less per month out of pocket – if you don’t consider the penalty that will now be assessed.

      With the $27 plan in place, should he need additional prescriptions for a short-term illness or pain relief – or should he require another maintenance medication every month – the insurance is in place to pick up the total cost of a generic or a co-pay on a brand name.

      For every year he goes without coverage, it’s going to increase his total premium (plan premium plus the penalty) should he decide to enroll in a plan.

      It’s heartbreaking to see the penalties individuals have when they delay enrollment. The highest I’ve seen in my state is $40 per month because they waited 5 years to enroll. Spouse was very healthy and they weren’t clear on Part D plans – but now spouse has taken a turn for the worse and prescriptions are very expensive out of pocket.

      I’m not trying to frighten you towards insurance – but it’s important to make an informed choice to delay or never sign-up for Part D insurance.

      • Gayle McLaughlin

        Thank you so much for explaining this penalty. I kind of remember something like this–but you explained it so plainly.

  4. If I assessed it and it turned out to be a very complicated matter, I’d let it go. I got one so that my mind would be at ease. But after knowing this, I don’t know.

    • Steve – Insurance can ease your mind. I would encourage you to do a comparison for all the plans in your area each year to be sure you have the best & least expensive plan in place for you.

      Of the clients that come into the local Area Agency on Aging in my area, 80% find that they can save between $200-2000 by switching plans (and occasionally pharmacies) for the upcoming year.

  5. Thanks Cherie.

    Some people may be wondering “How Do I Take Action?”.

    1. Go the Medicare website Cherie recommended
    2. Find out your current Medicare plan details on the site (or call Medicare at: 1-800-633-4227) – I recommend calling, the site can be cumbersome.
    3. Compare plans by going here (https://medicare.gov/find-a-plan/questions/home.aspx)
    4. Choose a new plan and alter it on the site

    Keep reading in Consumer Reports for other helpful details:
    http://news.consumerreports.org/health/2012/10/medicare-open-enrollment-how-can-i-find-a-better-plan.html

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