Frequently Asked Questions about Prescription Drug Plans
Originally published on November 15, 2016. Expanded and revised on August 24, 2021.
Part D drug coverage is arguably one of the most confusing topics of Medicare. Here are some of your most common questions, answered by your local Medicare agents.
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Why do I have to change drug plans each year?
Every plan changes every year. Premiums, copayments, deductibles, and what drugs are covered are subject to change. During the fall enrollment season, we run a new comparison to determine which plan is the best fit for you for the coming year.
Why aren't my spouse and I on the same Part D Plan?
When we use Medicare.gov to run drug comparisons, they are unique to your specific prescriptions. Given that you and your spouse probably take different medications, it is very likely that different plans will be the most cost effective for each of you.
Do I need a drug plan if I don’t take any medications or I’m only on a couple of generic medications?
Yes, it is recommended to have a drug plan to avoid a penalty for not having credible drug coverage. Plans start as low as $8 per month.
How do I set up an automatic bank withdrawal?
Your Part D provider will have a bank draft authorization form that you can complete.
Do I need a Part D plan if I have Medicare Advantage?
There are a couple of types of Medicare Advantage plans. One covers doctors and hospitals only. It is referred to as MA-only. There is also a Medicare Advantage plan that includes drug coverage. It is called MAPD.
There are only two types of MA plans that allow you to also have a standalone Part D plan – these are called Medical Savings Account (MSA) and Medicare Advantage PFFS. Otherwise, you must choose an MAPD if you want drug coverage with your Medicare Advantage plan.
In sum, if you choose an MAPD – a Medicare Advantage plan with drug coverage built-in – you do not need a standalone Part D plan. Your agent will help you to determine the best plan for you.
How much does Medicare Part D usually cost?
Each year, there seem to be a handful of plans with a very broad formulary and very competitive prices. With those plans, it’s common to see a premium under $25 per month.
Since I'm switching plans, when do I cancel my existing drug plan?
You don't have to do anything to cancel your existing drug plan. Once you've enrolled online or over the phone, it automatically bumps out your old plan. You carry your existing plan through December 31st, then begin using your new plan January 1st.
Do I need to call and cancel my current plan since I'm changing plans for next year?
No, when an enrollment is completed during the annual election period, your current plan will be notified and canceled automatically, starting January 1st.
Does it make a difference which pharmacy I go to?
Yes. A comparison is completed with the pharmacy of your choice selected. If you choose to go to a different pharmacy, you may be charged a higher price.
Can I get a 90 day supply for my prescriptions?
Most plans will offer a discount for 90 day supplies, but some drugs do have quantity limits, preventing you from getting a 90 day supply.
Do I get a discount if I have the same company for my Medicare supplement and my Part D drug plan?
No, there isn't a benefit or a discount to have the same company for both. There is also no discount to have a husband and wife on the same plan.
Read more: Should My Medicare Supplement and Part D Plan Be With the Same Company?
If I sign up on the Humana-Walmart Plan, do I have to go to Walmart to fill my prescriptions?
No, even if you're on the Humana-Walmart Plan, you are more than welcome to pick another pharmacy to fill your medications; however, your medications will likely cost you more money at a different location. That particular plan is deal between Humana and Walmart that offers lower prices for generic medications at Walmart.
If my doctor prescribes a new medication or two in the middle of the year, will this plan cover it? Can I change plans if my current plan doesn't cover a new drug?
Most of the time when a new drug is added, it is already on your plan’s formulary as a covered drug. If your new drug happens to not be covered, you will have to wait until the next annual enrollment period (Oct. 15 - Dec. 7) to choose a different plan that will cover your new drug.
Your premium does not change for adding new prescriptions, but you will start paying the co-payment for that drug at the pharmacy. Please refer to your formulary of drugs that your plan provides or call your agent.
Which drug plan should I choose if I go to a local pharmacy, such as Dale’s or Colee’s?
You should always go with a drug plan that fits the combination of your medications. Local pharmacies such as Dale’s Southlake/Colee’s Corner are preferred with a few of the available drug plans. We can help you make the best selection.
I, myself, go to Dale’s, because I like that it is a local pharmacy and I get great service.
If I get a new prescription that’s very expensive – even with my drug plan’s coverage – are there any tips for saving money on that prescription?
Make sure the prescription you’re taking is a generic (if it’s available). If it is a generic and it’s still a bit pricey, ask your doctor if there is a substitute that might be cheaper. As an example, lansoprazole (generic Prevacid) is used to treat heartburn and GERD and costs $130.94. You could ask your doctor about switching to omeprazole, the generic for Prilosec, which costs $62.66.
After that, check GoodRX for prescription discounts or coupons. You can print off a discount card to save money at a pharmacy near you. It’s quick and convenient. Second, consider asking for samples from your doctor.
When the fall enrollment season approaches, starting October 15th, we can do a new drug comparison and ensure you have a plan that’s compatible with your new medications.
Do I need a Part D plan if I’m still working and have insurance through my employer?
You do not need a Part D plan if you’re still working and have insurance through your employer.
If you are still working and on your group insurance, you should not enroll in Part B of Medicare. In order to have a Part D Plan, you need both Parts A and B of Medicare.
Whenever you do retire or decide to go off your group and enroll in Part B and purchase a Part D drug plan, you will be asked to provide proof of credible coverage and therefore avoid any sort of penalty.
When can I switch drug plans?
Folks can change their drug plan selection during the Annual Enrollment Period which runs from October 15th to December 7th. That change will be in effect January 1st.
How do I know if my drug pan is the lowest cost plan for me?
The best and only way is to utilize Medicare.gov’s plan finder tool. It takes into consideration your medications and pharmacy preference and organizes the plans by cost. It gives you great assurance that you are choosing the plan that saves you the most money.
It’s a fantastic program, but it’s not user-friendly for everyone. Call us and we can do a drug comparison for you!
What does prior authorization mean, and should I pay attention to it?
Prior authorization pertains to medications that your Part D Prescription Drug Plan company requires you and/or your prescriber to get special approval before they will cover the costs. Essentially, the prescriber needs to show that the particular medication is medically necessary for the insurance company to cover it.
In some cases, the insurance provider may also require this step to cover a medication that is permitted for certain medical conditions, but not others. In these situations, it is likely the plan has alternative medications on their covered list (formulary) to treat the conditions.
You do need to pay attention to this when selecting your Part D Prescription Drug Plan for the upcoming year. If you or your agent run a drug comparison through Medicare.gov, it will be able to tell you if your medications require prior authorization.
Most often, if one insurance provider requires it on a particular drug, others will also; however, in rare instances that is not the case, and you can find a company that accepts your medication without it. If you do have a medication that requires prior authorization, it is important to let your prescriber and pharmacist know before filling the medication so that they can assist you with the approval process.
How much does Medicare Part D usually cost?
Each year, there seem to be a handful of plans with a very broad formulary and very competitive prices. With those plans, it’s common to see a premium under $25 per month.
Conclusion
Medicare Part D is notoriously confusing – you are not alone! We hope our answers to some of these frequently asked questions help you make sense of it.
If you have any more questions about Part D drug plans, leave a comment below.
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