Medicare.gov website

This week, I used Medicare.gov to select my Medicare part D(medication) plan for 2020. I decided that it might be useful for any of you who also need to make this selection to walk you through the website and the decision-making process I went through in selecting which plan made the most sense for me.

If you are using original Medicare(as opposed to Medicare Advantage), the only major decision you should need to make annually is your medication coverage – Medicare part D.

This is something you should at least check annually, as every year there are changes made to all Part D plans, so even if you don’t change medications, there may be a plan that better covers your current medications, or your plan may no longer cover(or change the coverage of) one or more of your medications.

Getting started with Medicare online

If you’ve already created an account on the website, you just need to log yourself in using your email and password – if you haven’t yet created an account on the website, you should only need your Medicare card to create it. The other associated questions will be things like your address, phone number, birthdate and other identifying information.

Once it has confirmed your identity, the site will have access to information about both your Medicare plans and your prescription refills(if you already were on Medicare) as well as what your current plans are.

illustration of medicare.gov website
As you can see, I am on original Medicare and for 2019 I used WellCare Value Script for my medication coverage. I haven’t had any major problems with them, so would consider using them again – but it’s always best to double-check

It’s always worthwhile to make sure that the annual changes in the plans didn’t give me an option that would save me more money.

In an ideal world, you’d have all your medications saved into the system, including the form it is in(sometimes the costs vary) and the amount you take.

More likely, though, like me, you haven’t been keeping that fully updated, and so will need to create or update that information. The main advantage to keeping it up to date is that you don’t need to update it this time of year, and you likely could print a copy for your records or new doctor’s appointments.

This year, I noticed that they actually have gathered the details of many of the prescriptions I have filled in the last couple of months, which made it easier to build the list(I only had to select the name and confirm details on several medications.)

I did need to put in additional medications(the migraine medication trials knocked some of my regular prescriptions off the list), but it is relatively easy – you can start typing the name in, and the search box will autosuggest the medication, or you can read the list using their alphabetized list(and skip to the starting letter). Either way, the important thing is that this list is correct and thorough.

Setting your drug cost and pharmacy preferences

Once your medication information is entered, you can start actually selecting a new plan. The screenshot below is of search preferences and I highly recommend selecting to see your drug costs(because otherwise, how can you truly compare them?), and to select either retail pharmacy or both. Even if most of the time you get your prescriptions through mail order, there will be times when you can’t(such as getting an infection or illness or an urgent medication change).

Filling prescriptions by pharmacy is practically guaranteed to be more expensive than a mail-order request. Knowing that, I focus on the pharmacy costs so I am budgeting for the worst-case scenario

On the website, I needed to confirm where I live(by zip code), select pharmacies I prefer(up to 3 for comparison), and then I am taken to a list of available plans in my area.

This shows two pharmacies I selected in my local area – the one I’m currently using and another one that I’ve used in the past with minimal problems. I ended up selecting Rite Aide too for comparison.

I also have had a few changes in my medications this year. I do my best to take generic drugs and mostly have done well with them(this isn’t the case with everybody). This increases the liklihood that I will need to change plans.

This list of plan options can be organized by the lowest drug and premium costs, lowest yearly drug deductible, or lowest monthly premium. This year, I have 28 plans to choose from.

Previously, I only remember them listing options by monthly premiums, I am very excited by the change to these options – lowest monthly premium, lowest yearly drug deductible, or lowest drug and premium cost. As the tip mentions – if your medication list is correct, your lowest total expense should be at the top of that list!

My recommendation is to use lowest drug and premium costs option, as it’s most likely to help you find your best plan more quickly.

You can select up to three plans to compare at a time(easiest start is to select your current plan and the top two on the reorganized list), and this is where you need to be prepared to make comparisons

Comparing plans

I’m going to start by saying that everything about actual insurance plans seems designed to confuse the layperson(us). Medicare overall is one of the better options out there, but sorting through the part D plans can easily feel overwhelming simply because there are so many options and a lot of details that can be difficult to compare with one another.

Try to make it as simple for yourself as possible: your goal is to find the plan that leaves you spending the least annually. Sometimes that’s the lowest cost per month and sometimes the monthly expenses vary, depending on your plan selection and your medication needs.

I always aim for a relatively low and reliable monthly expense.

The screenshot below is of overall coverage and costs for the year for all of my medications. Notice that this list alone(comparing 3 plans) has annual expenses varying between $470 and $3570. That is for the exact same medications and dosages.

You will need to select the blue ‘plan details’ button to see how they arrived at those values.

three plan options listed – left is the new version of the plan I chose last year, the plans to the right are additional options. In my case, all of my drugs are covered, but may be subject to dose restrictions. The middle option has the lowest estimated total cost – $470 using a mail order pharmacy and $649 at Save-on Drugs.

Your goal is to get the most bang for your buck by balancing that sunk cost(your premium) and your monthly medication expenses. Some plans will leave you with different costs different months, while others are consistent throughout the year.

monthly estimated drug costs
This is a good example of even billing – this is what I prefer when possible.

Often on a limited budget, it’s a lot easier to plan for those reliable expenses instead of having your costs be more variable. Often the variation is based upon hitting your deductible or additional coverage needs.

Deductibles, gap coverage, and catastrophic coverage

You likely noticed in the image above that each plan mentions its drug deductible. All three plans listed above have a drug deductible of $435. This is the highest permitted deductible for 2020.

Until you hit your deductible, you pay those first amounts listed on the cost tables demonstrated in the next section.

The next step is the coverage gap.

For 2020, if you and your insurance spend over $4,020 on your medications, you fall into the coverage gap, a point where your insurance temporarily is limited on the support they give you for drugs.

Medicare does help you out, and you end up with a few discounts, but it is a hole in the coverage.

The coverage gap does not occur if you are using Extra Help.

Once you have spent over $6,350 in 2020 out of pocket, you move into the next category, catastrophic coverage. In catastrophic coverage, you have the lowest possible out-of-pocket expenses, though you may still have some copays.

If, like me, you are able to have relatively low medication expenses, you just stay in or near deductible costs, and only need to think about that first value on the tables.

If you know that you are going to have very high drug expenses, the deductible, coverage gap, and catastrophic coverage amounts become more important.

Generally, higher premium plans have lower deductibles, and you may need to balance the anticipated expenses with that in mind.

total estimated expenses
The top of this page mentions my estimated total expenses at their preferred pharmacy. Below that is an estimate of what I would pay each month. Notice that it starts high and decreases a little in April and again in May. Those decreases are due to this plan having me hit my deductible in April.

The good news is that total and monthly expenses, including hitting your deductible and coverage changes is calculated in, and those overall expense estimates include that consideration.

Preferred Pharmacies

So, remember when I mentioned pharmacies were also important? These images below should show you why.

Every plan has its own preferred pharmacies(and acceptable ones). The medication is usually cheaper in the preferred pharmacy than in the non-preferred one, and even that difference can change your costs pretty dramatically.

Here is an example of the listed charges for medication by tier. If you used this plan, the lowest you would pay per generic at a standard pharmacy would be $5, and you could pay up to half the retail price of the non-preferred drug. The costs change if you hit your coverage gap or catastrophic coverage, but because I generally can stay near my deductible in expenses, I focus on that first part of the table.

At the top, there is a selection box for calculating the expenses – you can select standard retail, preferred retail, or mail-order pharmacy.

Standard retail is generally the most expensive, and mail-order is generally the least. Since each program has its own preferred pharmacies, what your options on pharmacies are also may have a large impact on these costs.

Each plan will have variations on what tier they place which medication as well, so you want to not only aim to have your medications be as low-tier as possible but also on a plan that gives you the lowest possible copays for as many of your prescriptions as possible.

preferred pharmacy costs
This is the same plan, but their charges for a preferred pharmacy – the preferred generics have a $0 copay, and generics are only $6 instead of $11. The preferred brand is a couple dollars less, but the nonpreferred brand is only down 1 percent, and the specialty teird

If you only can use one particular pharmacy, or have a strong preference in terms of pharmacies, be sure to focus on plans where that pharmacy is a preferred partner(this will be listed in your comparison information form, or on the company’s website).

If you are more flexible on the pharmacy front, then recognize that you may end up changing pharmacies annually if necessary.

It’s often worth the hassle as you can literally save hundreds a month through using a preferred pharmacy(the more potentially expensive your medication, the more you might save).

Premium

No matter what, you’ll be paying for the plan each month, and that part alone seemed to run this year from $13 up ( I stopped looking at $60/month).

My Value Script plans premium has increased four dollars a month, but remains one of the less-expensive options. The Humana plan on the right is the least expensive drug plan available in my area.

While many people may fall victim to simply choosing the lowest premium, it’s usually low for a reason.

The more medications you take, or the more likely you are to be taking medications(especially newer more experimental medications) in the upcoming year, the more essential it is that your premium not be your primary consideration.

It is an important piece, but sometimes a higher premium actually decreases your monthly expenses.

Formularies

Each insurance program provides a list of medications that they cover and those that are preferred. Preferred medications are cheaper than the alternatives that the insurance covers and uncovered medications are generally the most expensive.

The formularies and the constant changes in them are one of the more unfortunate results of how broken our healthcare system is.

Since they change every year, you want to look for an insurance plan that covers all of your medication if possible.

If for some reason no plan has all your medications on the formulary, look for the plan that will give you the lowest total monthly expenses. Medications that are not covered may not be counted towards your deductible.

You are likely to receive the formulary for your current plan in the mail in October or so. Generally, it’s easier to check your information online using the site.

The first step for that is to look for the plan that decreases your drug costs as much as possible – covering the most expensive of your medications or charging you minimal amounts for the medications you are definitely using regularly.

This is why I find it essential to have a list of all the medications you take and consider what medication changes you may have in the upcoming year.

list of drug tiers and limitations
According to this provider, my medications are tier 1 to tier 3, 2 on tier 1, 3 on tier 2, and one on tier 3. That’s not too bad.
list of same medication under different insurance
According to this provider, my medications are tier 2 to tier 4, 4 on tier 2, one on tier 3, and one on tier 4. This practically guarantees that I will be paying more per month than I would with the plan above. It also implies that future medications I choose may also be higher tiers.

Drug tiers

Every provider has differences in their formularies, including what tier the medication is on.

As you can see, those valuations are not consistent – in some plans, most of my medications are considered first or second tier, while others place additional medications on the third and fourth-tier lists.

Generally, the lower-tier your medication is considered, the less expensive it should be, which is why it’s important to check multiple plans.

Tier 1 is the ‘preferred generic’ category mentioned in the preferred pharmacy section, with tier 2 being ‘generic’ and so on. With the large difference in charges for different tiers, you can see how the plan where your medication is in lower tiers can be advantageous!

Total cost

What matters most is the price you pay every month to cover your medication. That includes all of the pieces mentioned above.

The program will calculate your monthly medication expenses for you, so as long as your medication list is accurate, you have a reliable estimate for your monthly medication costs.

Once you add the premium to it, you have your total cost per month.

You then can use those costs for planning your budget and be prepared for what your actual medication expenses per month are likely to be.

screenshot of my 2019 plan updated to 2020
This shows the premium, estimated annual cost using the preferred pharmacy or mail order. This is the plan to beat – my goal through my searching was to find a plan where my total expenditures would be less than this plan, so under $990 at a preferred retail pharmacy.

With the medications I was taking last year, this plan, WellCare Value Script, was the best plan for me. This year, with a reasonable chance that I will be exploring additional medications to manage my migraine, I needed to double-check if this plan was still the best one for me. Spoiler alert: it wasn’t!

Enrolling in a plan

Once you find the plan that looks best to you – low total cost or a similarly low cost that seems to have more options(if you suspect you’ll need to shift prescriptions over the year), all you need to do is click the ‘enroll’ button on that plan.

selected plan box
This is the plan I selected. It gave me the lowest monthly costs at their preferred pharmacy and ranked all my drugs relatively low-tier.

The sign-in process is pretty straightforward, requesting identifying information and giving you the option of listing an emergency contact for you if you want to(I don’t see any harm in doing so, but I don’t really see a time when it would be really useful).

They will require you to list your medicare number again(at least now it no longer is your social security number), and once you fill in the information and affirm that you understand what you chose and that this will be your coverage starting in January, you’re almost done.

Paying for your plan

Once you have selected your plan, you do need to indicate how you will pay for it. The two main options are for them to send you a bill every month or to take the money out of your social security check at the beginning of the month.

I personally prefer to have the money taken out ahead of time so that I don’t need to think or worry about paying for my health insurance. Each month, my SSDI check is deposited into my bank account after removing the payments for both my Medicare part A and B and my Medicare part D.

If you don’t like having the money removed before you see the check, just select to pay monthly. You’ll get the bill each month and pay the provider each month for the coverage.

It does take about 2 months for the payment to be taken out of your check, so you may get a bill in January or even February depending on when you change your part D coverage if you choose to have it removed from your check.

Double-checking your new plan

So after going through all of the steps I laid out for you, I popped back on to grab some extra screenshots.

Much to my surprise, my plan name was completely different, though it had the same ID number.

selected plans screenshot
The plan for 2020 has the same identification number as the plan I selected, but is a completely different plan!

When I dug down, it appeared that all of the details were different, including the monthly cost(premium) and what tier my medications were on(instead of being primarily tiers 1 and 2, every single one was on tier 3), and of course the monthly anticipated expenses. This new plan is worse for me than my current one.

I learned that their livechat option can only be used for error messages and other forms of tech support(and step-by-step instructions to walk you through the site), so I have been informed that I need to directly call Medicare for my issue.

Knowing how long that will take, I tried to search the program on the company’s website only to find that neither Wellcare nor Aetna claim to have the part D program I signed up for.

Apparently WellCare and Silverscript both belong to Aetna, even though the WellCare Website doesn’t seem to make that claim.

I am calling Social Security this week to find out what happened. This does leave me feeling a bit less sure of the site, but I have not had a problem like this any previous year.

I still recommend selecting your plan on the site, but make sure to double-check a few days later to make sure that you are on the plan you initially selected.

Conclusion: You can choose the best Medicare Drug Plan for you!

Medicare part D is the only part of Medicare that needs to be adjusted annually.

In this post, I’ve walked you through the information that I consider in making my decision and discuss what my priorities are and why.

Your goal is to find the plan with the lowest total cost for you. That lowest cost includes reasonable expectations – picking up medications from a pharmacy you can go to, with your medications mostly being on relatively low tiers.

If you suspect you will have major medication shifts over the year, you may want to look into some higher-premium plans as they often are more flexible and cover more medications.

Premiums are your monthly payments to the insurance company, while your deductible is how much you need to pay before you get additional help from your insurer.

If you know that you are going to have very high medication expenses, the rules around catastrophic and gap coverage may be very important for you, while if you don’t anticipate going much over your deductible they are less significant.

Follow through on your search until you find a plan and pharmacy that work for you. You can double-check yourself by comparing the anticipated annual cost of your new plan to your old.

I hope that this will help you to do your research and find the best possible plan for you!

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