Comparing Part D plans can be a pain! Aside from the formulary and monthly premium, you need to compare the deductibles, copays and whether a plan includes coverage in the gap.
There are some things you don’t have to worry about. The Part D Standard Benefit Model sets many of the parameters that apply to all plans.
This model can change each year, but you will be notified from your current plan when they mail the Annual Notice of Change.
Standard Medicare Part D benefit parameters
Each year CMS sets parameters for Part D plans. Providers of Part D can offer unique features and benefits, as well as set competitive premiums, but they cannot alter the following parameters.
- Plans can include a deductible of $325.
- Initial coverage limit is $2970.
- Maximum out-of-pocket (MOOP) threshold is $4750.
- Minimum co-pays (catastrophic Portion of benefit) is $2.65 for generic/preferred and $6.60 for all other drugs.
Since Part D is a federally regulated program all Part D Medicare plans have the same limits.
Medicare Part D Donut Hole for 2013
Part D plan members will receive a 52.5% discount on their name brand drugs in the coverage gap. If you have ever reached the coverage gap you know that saving 50% on your name brand drugs can be a significant savings. You will only pay 79% of the cost for generic drugs while in the donut hole.
Comparing Medicare Part D plans – what to consider
Most Counties will have at least a couple dozen Part D plans to choose from. You will see recognizable plans such as AARP Medicare Part D plans and Humana Medicare Part D plans as well as a host of plans that you may never heard of.
You can make an informed decision is you keep these factors in mind:
- Medicare Part D plans are annual plans and unless you are dis-enrolling from a Medicare Advantage you will have the plan through the end of the year.
- Make sure your drugs are included in the plan’s formulary.
- Determine which tier a drug is in and compare that to other plans. Sometimes one plan will have a drug in tier 2 while another company will place the same drug in tier 3.
- Don’t get fooled by a low premium,only to have a $325 deductible. Do the math to look at the whole picture.
Too many people choose a plan based on the premium and the co-pays rather than looking at the entire picture. Also make sure your pharmacy will readily accept the plan as sometimes small pharmacies do not accept all plans.
The easiest way to compare Medicare Part D plans is online. Once you find a Part D plan you can generally submit the application online and avoid meeting with an agent.