This post takes you through when 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.
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).
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.
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). The medication changes increases the likelihood 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.
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.
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.
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($4,430 for 2022), 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($6550 in 2022) 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.
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.
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.
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).
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.
An update to this – when my migraines kicked in, I had to completely switch what programs I focused on. The new CGRP inhibitors are extremely expensive, so I had to look into much higher premiums. My comparison for this year looked very different.
As you can see here, the WellCare Value Script coverage still has a low premium, but doesn’t cover the two CGRP medications(one of which I’m taking, the other of which helps but is primarily for breakthrough headaches), which makes it prohibitively expensive.
These amounts are for the year, but you can see a $22,000 difference between the coverage options annually. That difference is very close to my annual income. You can see why I’m going with the plan with the highest premium.
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.
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.
With the medications I was taking in 2019, this plan, WellCare Value Script, was the best plan for me.
When I decided to explore medication options for 2021, I came up with a completely different solution – which I’m sticking with for 2022.
It has no deductible and covers both the medications I’m currently taking AND the other CGRP inhibitor that I’ve also found helpful. That one is by far the most expensive, and if I take it, it’ll be an as-needed for breakthrough days, rather than as a daily medication.
The only accurate cost on there is the monthly premium, but as I mentioned above, the worst-case option is $20,000 cheaper – and it’s by far the most affordable with the medication I plan to continue taking!
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.
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 SSDI check.
A word of warning: the only time that having my part D plan removed from my check caused me any grief was during an application for Charity Care.
If you anticipate using that program, I recommend paying directly for your part D coverage, so that all your financial information lines up more easily for them.
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.
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 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.
It also turned out that I had no problems, and once the new year started, I was on the plan I selected, rather than the plan they showed. I still have no idea why this problem occurred.
The issue did not occur the following year when I switched over to the Blue Cross Blue Shield Plan.
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!
