There are certain words we kept coming across as we researched Medicare Part D: “maze,” “variables,” “many moving parts.” Like any other system in which government agencies and private enterprise are intertwined, it’s complicated.
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Plus, factors such as location, age, prescriptions and preferred pharmacies often affect your choices.
Since 2014, we've provided detailed guides to companies that offer Medicare Part D plans and websites geared toward directing you to the best Part D plan in your area.
When choosing your prescription drug coverage, you don’t want to wind up hurting both your health and your wallet. Below you'll find some advice, tools and professionals that can help you navigate the process.
Why trust us?
Top Ten Reviews has covered senior care technology since 2011. We've included this guide to Medicare Part D plans since 2014 as a resource for your purchasing decision. However, it's important to understand that this is not a review of Medicare Part D plans. We did not review, rate or rank the plans. We have not recommended one plan over another, in part because the quality of the plans depends largely on your personal situation and what is available in your area.
Rather, you should view this as a simple guide to help you understand the types of Medicare Part D plans that are available and what you should know before you pick a plan.
Best use of star rating
When visiting the Cigna website to shop for Medicare Part D Plans, the first thing you will likely notice is the ease of navigation through the various plans available. The site also does an excellent job at both showing and explaining the Medicare Part D five-star ratings, which are evaluations made each year based on overall performance. Even when the plans have below-average ratings, Cigna makes the effort to be transparent, which is worth noting.
You have the choice of the Cigna HealthSpring Rx Secure Plan, the Cigna HealthSpring Rx Secure-Xtra Plan or the comprehensive Cigna HealthSpring Rx Secure Max-Plan. In order to choose the plan that best meets all your needs, Cigna asks that you consider the medications you are currently taking and your desired deductible and copay.
The Cigna HealthSpring Rx Secure Plan features low monthly premiums, which is ideal if you are looking for basic coverage. The Cigna HealthSpring Rx Secure-Xtra Plan also features a low monthly premium but comes with the added benefit of no deductible. The HealthSpring Rx Secure-Max Plan is the most inclusive Medicare Part D Plan offered by Cigna with the broadest coverage. It does not have a deductible and offers the added benefit of gap coverage, but it has a higher premium. While the premium for the Secure-Max Plan will be a bit higher than the traditional Cigna Part D Plans, this plan is ideal for individuals that can afford a bit more and don’t want the surprise of out-of-pocket expenses.
Read the full review of Cigna HealthSpring Rx Plan
Best for pharmacy-based plans
Since many insurance providers negotiate with pharmacies to get specific prices for drugs, the most affordable plans are often pharmacy-based, such as the AARP Walgreens Rx Plan. By negotiating the deal with Walgreens, you can get an affordable, low-deductible and low-premium plan with wide coverage, but only if you're okay with using a Walgreens pharmacy. Fortunately, since there are over 8,000 Walgreens in the U.S., there is a good chance that you live close to one.
The AARP is partnered with the UnitedHealthcare Insurance Company. This allows you to get the AARP Walgreens Rx plan even if you are not an AARP member (so long as you are a Medicare recipient). With AARP, you can choose between several plans. You aren't limited to the Walgreens plan. The Medicare Rx Preferred Part D Plan features no deductible and a higher premium. It comes with comprehensive coverage that includes generic drugs and most common brand name drugs. The Medicare Rx Saver Plus Plan has a higher deductible but a lower premium. It may be more affordable but doesn't cover nearly the same number of drugs.
When getting a quote or applying for an AARP Medicare Part D plan, you may be redirected to another page to view details about AARP Part D Plans. Here you can view a side-to-side comparison of the plans available to you based on your criteria and search options. Keep in mind that the total annual cost shown is only an estimate and may change based on your prescriptions, pharmacy and quantities. You may receive a more accurate annual cost quote by entering a detailed list of your current prescriptions.
Read the full review of AARP UnitedHealthcare
Best for comprehensive Rx plans
The Humana Preferred Rx Plan is an excellent example of the type of Medicare Part D plan that features comprehensive coverage that is accepted at a wider range of pharmacies, unlike the pharmacy-based plans. These plans usually have a higher premium but are an affordable option if you have a lot of prescriptions that need coverage. In addition, it's accepted at Walmarts, Walgreens, and Sam's Clubs, which gives you many more options.
That said, Humana's highest rated plan is the Walmart Rx Plan, which is more affordable than the Preferred Rx Plan, but only accepted at Walmart pharmacies. Your prescription drug cost and coverage is based on use of the Walmart Pharmacy network, which has been negotiated to get you the best prices. This means your copay is lower at Walmart. Other pharmacies will still accept the plan, but the copay will be much higher.
As with most Part D plans, the monthly premiums are largely dependent on the medications you take. To get a more accurate estimate of your expected out-of-pocket costs for your prescription drugs, you can add your prescription and pharmacy information before online enrollment. The Humana Walmart Rx Plan offers prescription drug coverage by tiers. This information and more is available on the Humana website.
Read the full review of Humana Preferred Rx Plan
Best resource for California residents
The California Health Advocates website can help answer some general questions about basic Medicare coverage and which plans may be right for you. If you are considering a Medicare Part D Plan, this site can help you understand your eligibility and rights. It is important to know that if you are eligible for Medicare or are a Medicare recipient, a Medicare Part D Plan is available to you regardless of past or current health conditions. California Health Advocates provides an overview of prescription drug coverage and step-by-step instructions on how to enroll in a Medicare Part D Plan. They even provide information for individuals that may need extra help paying for their Part D Plan premium.
The website answers questions and provides explanations for some of the more confusing parts of Medicare Part D Plans. If you have visited the site and still have questions about enrolling in a Medicare Part D Plan, you can utilize the California Health Advocates’ one-on-one counseling. This service is free and provided to you by the Health Insurance Counseling & Advocacy Program Office.
It is important to remember that the California Health Advocates is not an insurance company and cannot enroll you in a Medicare Part D Plan. This website is an informational tool only and should be used with other resources to help you make an informed decision about which plan is best for you. If you would like to enroll in a Medicare Part D Plan, the website provides a link to a Medicare Plan Finder tool at the bottom of the Prescription Drug Resources page. This link redirects you to the Medicare.gov website, where you can compare plans available in your area side-by-side.
Read the full review of California Health Advocates
Best for expert help
WellCare is an insurance provider specializing in government-sponsored healthcare plans for Medicare, Medicaid and Medicare Part D prescription drug plans. The provider has three Medicare Part D plans – the Value Script, Classic and Extra. While many Medicare providers, such as Cigna and Humana, are largely focused on general healthcare insurance, WellCare is focused only on government-sponsored healthcare plans. This means the expertise put into the resources and customer service is ideal when you want to work with people who understand all the ins-and-outs of these plans and the issues pertaining to them.
WellCare’s Part D plans feature low monthly premiums and no deductible. Some plans also have no co-pay on generic drugs. There are currently 60,000 in-network pharmacies, which isn’t as much as the bigger providers, but there is still a good chance you’ll find a pharmacy in your area. WellCare is partnered with CVS, Target and most independent, regional pharmacies. This makes it the ideal choice for seniors who prefer not to be tied down to Walmart or Walgreen pharmacies, which tend to be partnered with larger insurance providers in the market.
As with all Medicare Part D plans, availability is a consideration you have to weigh before you decide to enroll. Availability, as well as the cost of premiums, are dependent on location.
Read the full review of WellCare Classic
How much does a medicare Part D Plan cost?
According to MyMedicareMatters.org, the national average monthly premium for a Part D plan is $33.19. However, the cost varies depending on the plan you choose and the area where you live. In addition, to really determine the best plan for you, you need to consider the cost of the drugs you take plus the deductible and premium. You shouldn’t necessarily choose a plan based on the lowest available premium without first determining how the plan affects your annual drug costs, as it’s important to remember that Part D plans usually don’t begin to cover prescription drug costs until you’ve paid the out-of-pocket deductible. So, if a low premium plan has a high deductible, it can potentially cost you more per year than a higher premium.
To find the most affordable plan, you need to start by making a list of the prescriptions you take and the monthly cost without insurance. Then calculate the annual cost of the drugs. This might require consulting with your pharmacy or past receipts. Once you know how much your drugs cost, you can choose a plan with a deductible and a monthly premium that costs you the least.
It’s also critical to consider the co-pay tier categorizations of the drugs you take. Medicare Part D plans will always emphasize or encourage you to take the tier 1 generic drugs, and most cover these at a much lower co-pay. But if you have some drugs that are only available on the tier 4 speciality designation, you could end up with a higher co-pay.
How we evaluated
While every plan is different, they all share the same cost considerations:
Similar to other commercial health insurance plans, Medicare Part D Prescription Drug Plans vary with the monthly premiums, depending on the company and the coverage and the prescriptions you need covered. We've seen monthly premiums as low as $12 and we've seen some as high as $100 per month. It all depends on how comprehensive you want or need your plan to be. To help you know what your premium will be, you should collect your medications and list the names, brands and dosage. Most insurance providers will ask you to provide this information when getting a quote for a plan.
Some Medicare Part D Prescription Drug Plans offer a low monthly premium with a high deductible, while others do not have a deductible but charge a higher premium. When choosing a Medicare Part D Plan, pay close attention to the benefit of paying a higher monthly premium. In many cases, the difference in savings is not as much as the difference in premium. The coverage of a higher premium plan often provides more comprehensive coverage.
Depending on your budget, current medications, and location, you can search among a vast list of plans offered by several commercial insurance companies. Most companies offering Medicare Part D Prescription Drug Plans cover medications based on a tier program, and not all medications may be covered. It's important to compile an accurate and complete list of your current medications before enrolling in a Medicare Part D Prescription Drug Plan to find out if they are included under the plan.
Similar to other health insurances, you have to pay attention to enrollment periods. With Medicare, you have an initial enrollment period, which is seven-months and includes the three months before you turned 65. After this period, if you haven't enrolled in a plan or if you want to change your plan, you have to wait until the Fall Enrollment period, October 15 to December 7, with effective coverage beginning on January 1st.
Medicare Part D resources to consult
State Health Insurance Assistance Programs are federally funded, state-managed centers that provide free counseling about Medicare over the phone or in person. The staff and volunteer experts in the programs use the same Plan Finder as you would on your own, but they’ve undergone extensive training and have experience navigating through the challenges these choices present.
“We ask [consumers] questions to try to help them decide,” says Ray Walker, divisional director for the Medicare Assistance Program (a SHIP) at the Oklahoma Insurance Department. “What is the most important thing to you: Having a short drive to the pharmacy? Is mobility an issue for you? [Is the priority] the copay structure for this particular medication?”
Though SHIP counselors are not allowed to recommend one specific plan, by asking these questions and evaluating which plans’ formularies best suit a person’s needs, they’re able to narrow down the choices significantly. Walker estimates that consumers who follow his staff’s advice save an average of $2,100 a year. And since the services are free, you can call your state’s SHIP any time throughout the year, especially during every open enrollment period, when you need to decide whether to keep your current plan or switch to a new one.
“We always recommend SHIPs as a resource for people who want more-personalized help with sorting through their Medicare plan options,” Purvis says.
You can find your state’s SHIP website in this drop-down menu.
For laser-focused advice: licensed insurance agents
Brokers have a lot of training and expertise under their belt, and a good one will be able to spend quality time looking at your individual needs at no cost to you. Be aware, though, aware that most agents work on commission and are in business to sell plans for the companies that will be paying them. One way to make sure you’re dealing with someone who has your best interests in mind is to go to an agent who represents a number of insurance companies.
“Ask them: ‘Do you sell all the plans that are available, or do you only represent certain companies?’” Walker advises.
For unbiased hand-holding: flat-fee medicare consultants
“It makes sense to me,” is how Diane Omdahl describes her Medicare expertise and resultant understanding of the enrollment process. Omdahl, cofounder and president of 65 Incorporated, is a registered nurse and directed a skilled nursing facility before getting into the Medicare advice business. Services such as 65 Incorporated, Allsup Medicare Advisor, Health Care Navigation and others you can find in your area charge a fee for one-on-one consulting. It’s not cheap; 65 Incorporated charges $399 to walk you through your initial enrollment. The advantage is that because these consultants do not work on commission, they have no ulterior motive to steer you to a particular company or a more expensive product.
Considering how much you might have to pay out of pocket for an uncovered medication if you choose the wrong plan, it may be worth your time – and possibly some of your money – to get a helping hand with the process.