How to Find the Best Medicare Part D Rx plan

medicarerx2023 Medicare Part D Rx plans can really help you fight the cost of prescription drugs.  In most cases the costs of prescriptions are decreased by up to 75% and sometime higher.

OPEN ENROLLMENT  –  These prescription plans are considered Medicare Advantage plans which have “open-enrollment periods.”  The most common is the Annual open enrollment period running from October 15 through December 7 of each year.

This is the time all Medicare members are able to view, compare and change Part D Plans.  Any changes will be effective January 1.

Enrollment Opportunities:

  • Initial Enrollment Period (IEP) when a person first becomes eligible for Medicare, they have three months to enroll in a Medicare Part D plan, from the time their Medicare coverage starts.  After this three month window closes, they will be locked out until the next open enrollment.
  • Annual Enrollment Period (AEP) – This is the time each year you are able to change Part D companies or stay with the same plan.  The AEP starts each year on October 15 and ends December 7, for an effective date of January 1st.
  • Special Enrollment Period (SEP) If you are exiting an employer health insurance plan, or if you have moved outside of the plans service area, both allows a two month open enrollment period for you to choose and enroll in a Part D plan.

Another common “special enrollment period (SEP)” is if a person who is currently is enroll in a Part D plan, but moves their residence outside the the Part D plan or company service area.  Or, if a Medicare Advantage plan does not renew or offer coverage the next year.  These situations also allows a two month open enrollment period to find a new plan in your county of residence.

ALSO – If you if you move into, reside in, or move out of a qualified institutional facility: a skilled nursing facility, nursing home, psychiatric hospital or unit, Intermediate Care Facility for the Mentally Retarded—ICF/MR, rehabilitation hospital or unit, long-term care hospital, or swing-bed hospital.  These all provide SEP opportunities anytime of the year.

Where to Compare Part D Plans:

One of the best places to compare all of the Medicare Part D plans in your county is the Medicare website.  There will typically be 25 to 30 plans available in your county.

Be sure to compare all plans because each plan and company will provide a different level of coverage for your prescription list.

Choosing the right Part D plan will benefit you greatly when paying for your meds throughout the year.  On the other hand, choosing the wrong plan may cost you hundreds and potentially thousands of dollars more.

Unfortunately the Medicare website isn’t an easy site to navigate.  When entering your meds, dosage and frequency you need to be very accurate, and double check your entries.  If you are not familiar with the website mistakes can be made, altering the results.

2022 Part D Coverage Details …

Private insurance companies are the only place to purchase a Part D Rx plan.  And most follow a “Standard Benefit Plan Outline” which is as follows:

  • Initial deductible ($505) – Some plans may have an annual deductible, while others do not have any deductible at all, allowing “first dollar coverage.”  After the deductible is met the Plan pays 75% and you pay 25% of the covered costs until the total prescription costs meet the initial Coverage Limit.
  • Initial Coverage Limit ($4,660) – Once you satisfy a deductible, then you will most likely have copays for each of your prescription drugs.  This coverage limit extends to the point where the total retail cost of the medication(s) reach $3,750.
  • Coverage Gap “Donut Hole”  ($4,660 – $7,400) – Next is the “Coverage Gap” (Donut Hole) this part of the plan is when you have your retail costs of your prescriptions reach a total of $3,820.  At this point you will pay 56% of your “Generic” drugs and the 65% of your “Brand” drugs, until your total prescription retail price cost reaches $5,000.  You get these savings if you buy your prescriptions at a pharmacy or order them through the mail. The discount will come off of the price that your plans has set with the pharmacy for that specific drug.
  • Catastrophic Coverage ($7,400) – After the Donut Hole you enter the “Catastrophic Coverage” portion of your plan.  This is when a person has spent more than $5,000 in prescription costs.  At this time, they will be protected by the Catastrophic Coverage which typically covers 95% of their drug costs for the balance of the year.

Looking for a Medicare Supplement or Medicare Advantage?  Click Here.

“I do not sell Part D plans but I’m happy to help you with your search.  I help my clients every year go through their Part D options, so feel free to call or email anytime.”

No Cost Help … there is no charge for my services.  The insurance companies provide a fee for me to help with coverage options, enrollment and service.

John Conner

John Conner

Medicare Plan Options ... Medicare Supplement, Medicare Advantage, Medicare Part D Rx