Questions to ask when comparing Part D plans

Medicare Part D enrollment

When you are choosing among Part D plans, here are some questions to keep in mind. Before you start looking at plans, make sure you know:

  • The prescriptions you take, including their dosages and usual costs (you may want to ask your doctor for help creating a list)
  • The pharmacies you regularly use

Drug coverage

  • Are my prescriptions on the plan’s formulary?
  • Does the plan impose any coverage restrictions, such as prior authorization or step therapy?
  • If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)

Costs

  • How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need?
  • How much will I pay for monthly premiums and the annual deductible?
  • How much will I have to pay for brand-name drugs? How much for generic drugs?
  • What will I pay for my drugs during the coverage gap?
  • If a drug I take has a very high coinsurance, is there a drug I can take that will cost less? (Ask your doctor.)
  • Am I eligible for Extra Help or a State Pharmaceutical Assistance Program (SPAP)?

Pharmacy network

  • What is the service area for the plan?
  • Can I fill my prescriptions at the pharmacies I use regularly?
  • Can I fill my prescriptions when I travel?
  • What will my coverage options and costs be if I visit out-of-network pharmacies?
  • Can I get prescriptions by mail order?

Coordination with other insurance