Medicare prescription drug plans: annual review

Karlyn M. Jones Wealth Planning

Most Medicare recipients who have a prescription drug plan fail to understand the importance of an annual review. Knowing when to revie­w, what you need to know to review, and how to review will help you to save time and money. According to New Yorker Magazine, less than 23 percent of Medicare prescription drug plan enrollees take advantage of reviewing plan options each year. Joe Baker, past president of the Medicare Rights Center in New York, reminds us not to “stay in a plan because you’re overwhelmed with the choices.” If it is time for you to review, be sure to know the answers to the following questions:


During the Medicare Open Enrollment period plan, participants have the ability to review their current prescription drug plans with all drug plans. Medicare Open Enrollment runs each year from October 7th to December 15th. During this period, prescription drug plan participants are given the opportunity to review options available for the coming year, with new plans to begin on January 1st.


These standalone prescription drug plans (better known as Medicare Part D) are offered by private insurance companies to Medicare-eligible insureds. Each year these insurance providers and their plans enter and exit the marketplace. Also, insurance providers renegotiate their plans with pharmacy networks. Drug formularies (the lists of covered medicines), the prescription costs and your co-pays can change from year to year as well.


The Medicare website offers Medicare insured individuals the ability to review prescription drug plans on their website. On the Medicare website you will be required to input your current prescriptions, the current dosage for each prescription, your pharmacy and your home zip code. The website will show you the best prescription drug plan options for you. From these options you can choose to enroll into the plan that covers your prescriptions, has your desired deductible, co-pays and premium. Premiums can be paid by a monthly coupon book, automatically drafted from a bank account or deducted from your Social Security check if you are receiving benefits. It is important to note that there are knowledgeable independent health insurance agents in your area who can assist with this annual review.

How much?

Prescription drug plan premiums vary by plan. When shopping for a new plan, look at more than the premium alone. Consider that the best and least expensive plan for you is one that has your prescriptions in their formularies in addition to the lowest co-pays and deductible. According to the Centers for Medicare and Medicaid Services the average monthly premium for such plans is estimated at $32 a month for 2015. Higher income earners pay more for prescription drug plans. For example, a single person with an income greater than $85,000 (and married couples with an income greater than $170,000) will pay higher monthly premiums. These factors change each year depending on plan choice, reported adjusted gross income and filing status. If you have limited income and resources, you may qualify for Extra Help to pay for some of your Part D costs.

With the ever-increasing costs of prescription drugs for some millions of older Americans, an annual review of your Medicare Prescription Drug Plans is a smart financial decision—one that will give both you and your family peace of mind in this costly and complicated health insurance arena.

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