If you have Medicare Parts A and B (original Medicare), you will also need to get a drug plan, Part D. Luckily Medicare.gov has a handy tool for comparing Part D plans in your area and providing you with pricing information to help you make your selection.
When you compare plans, you have to make sure your Part D coverage includes your medications. You have to check your medications every year to make sure your current Part D coverage still carries the medications you need. If not, you need to change plans, but your Part A, B, and supplement coverage do not change.
Note: You can use this same tool to find Medicare Part C Advantage plans with and without drug coverage. To find Part C plans, follow the steps described here up to and through the Refine Your Plan Results section.
See Signing up for Original Medicare for information about the timing rules for signing up for Part D. If you do not sign up in time, you might have to pay a penalty for as long as you have Part D.
Use the Tool
You need to step through a number of screens and provide information about your situation before you can find out what plans are available to you. The important things are 1) Where you live (zip code) because not all plans are available everywhere, 2) What drugs you need because not all plans carry all drugs, and 3) Pharmacies because prices vary based on the relationship the drug company has with a particular pharmacy.
- Go to https://www.medicare.gov/.
- Click the Find Health and Drug Plans button.
- In the General Search box, enter your zip code. Available plans vary by zip code.
- Click the Find Plans button.
- In the Enter Information page, select whatever applies to your situation.
- Click the Continue to Plan Results button. This button is a bit misleading because the next screen is where you enter your prescription drug information.
Enter Prescription Drug Information
- Use the Type the name of your drug tool to find and add your prescription drugs to the list.
- If you are not on any prescription drugs (lucky you!), select the I don’t take any drugs button.
- Use the Retrieve My Saved Drug List option on the right to save your drug list. That way, you can retrieve it every time you come here without having to re-enter your prescription drugs.
- If a generic form of your prescription drug is available and it’s in the Medicare system, the tool will let you know and give you the option of selecting it. Sometimes the generic is available before Medicare has it in its system. Not to worry because the pharmacies will fill your prescription with a generic if it’s available.
- Use a retail pharmacy if you can. Mail order costs more in Medicare, but is of course necessary for people who have trouble getting to a pharmacy.
- Click My Drug List is Complete.
Select Your Pharmacies
This screen lets you add two pharmacies where you want to pick up and pay for your prescriptions. Later after the tool gives you available plan results, you will have an opportunity to add and delete pharmacies to find the best deal for you.
- Many plans have negotiated deals with certain pharmacies, which results in lower costs to you, the consumer. These pharmacies are known as Preferred Pharmacies.
- Many plans also work with non-preferred pharmacies where the costs to you will be higher than they would be at a preferred pharmacy.
- You might not be able to get your drugs through some pharmacies if the drug company does not have a relationship with that pharmacy.
At this point, just select a couple of pharmacies that are nearby.
- Indicate how far you are willing to travel to a pharmacy.
- Click Continue to Plan Results.
Refine Your Plan Results
This screen let’s you decide whether you want to view results for Original Medicare with Part D, or find a Medicare Part C Advantage Plan with drug coverage or without drug coverage.
- Select Prescription Drug Plans (with Original Medicare).
- Click Continue to Plan Results.
Note: From this point on, the instructions are specific to Original Medicare with Part D.
Your Plan Results
The plan results page lists your current plans (Medicare Parts A and B) and potential prescription drug plans (Part D).
The top part of the results page provides an estimate of your current Original Medicare costs.This is an estimate based on actual usage by people with Medicare, so the true costs to you will vary based on your age and health. Also, your Part B premium costs might be higher if you had a lot of income in the prior two years.
- Click Original Medicare (H0001-001-0) to see a page with the costs breakdown, which excludes Part D coverage.
- Column 6 above shows Estimated Annual Health and Drug Costs of $7,020 including $3,556 for drug costs. This is an estimate of drug costs under the Part A Hospitalization plan (not Part D). If you are not hospitalized during the year, these drug costs do not apply.
- Click any blue question mark (?) for more information.
Prescription Drug Plans
The second part of the page lists the prescription drug plans that carry the drugs you entered on your drug list. You can change the sorting order based on how you want to see the information.
Note that in the Drug Coverage, Drug Restrictions, and Other Programs column the Yes next to Drug Restrictions. For the example, I put in a drug that requires prior authorization.
Prior Authorization means that before you can get the drug through a Part D plan, you have to have your doctor’s office contact the plan to have the plan fax the doctor’s office a form on which they apply for the prior authorization. Without the prior authorization, you cannot get the drug through Part D even if you have a prescription. You have to renew the prior authorization every year whether or not you stay with the plan.
The first plan, Aetna Medicare Rx Saver (PDP) is the least expensive according to the sorting order, but shows a $360 deductible, which could lead you to think that this plan is really going to be quite expensive. To find out why the next plan down is not the cheapest, you have to review the details, as follows:
- Click Aetna Medicare Rx Saver (PDP).
- On the Your Plan Details page scroll down to What You Pay.At a CVS pharmacy, which is not a preferred pharmacy for this plan, you pay the full cost of the drug, which is $19.00. Once you meet the deductible, the cost goes down.
At a Walgreen’s pharmacy, which is a preferred pharmacy for this plan, before you have met your deductible, you pay the full cost of this drug, which is $4.00. Once you meet your deductible, the cost goes down.
If you opt for mail order, you will pay the most, which is $26.32 for the drug plus additional charges for the mail order service. As before, once you meet the deductible, the cost goes down.
Full Cost of Drug
What has happened is that the drug plan listed first, Aetna, has negotiated with some pharmacies to get very low drug costs. These preferred pharmacies have contractually agreed to the lowest prices. For example, the next Part D plan down, First Health, charges $58 for the full cost of the drug and has a higher monthly premium, but no deductible.
So even with a seemingly high deductible in the Aetna plan, in the case of this drug at least, paying the full cost does not cost very much. That is why Aetna is the cheapest plan.
You won’t know ahead of time which pharmacies are preferred because you won’t know which plans will come up until you get the list from this tool. But you can use this tool to add and delete pharmacies, and to find out which ones are preferred. You can also call the Plan company or visit their website to find out which pharmacies are preferred.
- Scroll down to Pharmacy and Mail Order Information.
The section points out that there are 7 preferred pharmacies in your zip code.
- Click 7 preferred pharmacies.
- On the Pharmacy List: Aetna Medicare Rx Saver (PDP)(S5810-066) page, you can, for example, remove the CVS pharmacy, and then add the Lucky pharmacy, which is a preferred pharmacy.
Note: You have to scroll down the page to see the Lucky pharmacy.
This blog post provides an overview of the tool. Spend some time using until you are comfortable with how it works and what the information means.