The 5 C’s For Choosing a Medicare Part D or Advantage Plan

Coverage – First, you want to ensure that your prescription medications are covered by this Medicare drug plan. Are there lower-costing generic alternatives available for your brand-name drugs? How large is the plan’s formulary (or drug list)? If your chosen plan does not cover all of your medications, can you work with this plan to get a formulary exception? (Formulary Exception practices are also good to consider should you need a medication later next year that is not covered on the existing formulary.) What price-tiers apply to your medications? Are there any additional Usage Management restrictions? If you would like to have Medicare Part A and Medicare Part B coverage along with your Part D coverage, you might ask: What health coverage does the Medicare Advantage plan offer beyond basic Medicare? Are there any additional benefits offered by the plan? Are all of your doctors and specialist part of the Medicare Advantage plan’s provider network?

Cost – What are the monthly plan premiums? Does the Medicare Part D plan or Medicare Advantage plan have an initial deductible? What are the co-payments or co-insurance that you pay for your medications or healthcare? What are the plan’s coverage limits? Is there any prescription coverage in the Donut Hole?

Convenience – How difficult is it to find a pharmacy or a health care provider? (Note: most national Medicare Part D plans have a pharmacy network of over 50,000 pharmacies.) Are your restricted to any healthcare network (such as an HMO)? Do your doctors accept this Medicare Advantage plan? How easy is it to work with this Medicare Part D plan or Medicare Advantage plan?

Company – Is the company who provides the Medicare Part D or Medicare Advantage plan important to you? Often people choose a Medicare plan based only the Medicare plan provider’s reputation or recommendation. Does the Medicare Advantage plan have a reputation of dropping doctors from their healthcare network? Does the Medicare plan have a reputation of changing coverage each year? What is the Medicare plan’s overall and individual Quality or Star ratings?

Comfort – Would you rather not change plans each year? Are you comfortable with your current Medicare Part D plan or Medicare Advantage plan? Would you rather spend a few extra dollars per month because you know your healthcare providers, have an idea how your current Medicare plan operates, and your plan costs are predictable (even though slightly more expensive)?