01
The monthly premium
What you pay whether or not you fill anything. The number in the advertisement, and the least useful of the four for predicting your year.
Coverage · Part D
The plan is chosen by your medication list, not by its premium.
Two drug plans with the same monthly premium can differ by thousands of dollars a year for the same person, because each covers a different list of medications at different tiers. This is the one place where the cheapest plan is most often the wrong one.
What to bring
- Every medication, by name
- The dose and how often
- Which pharmacy you use
- Anything a doctor has just added
Photograph the bottles if that is easier. We have done it from photographs many times.
The penalty nobody warns you about
Skipping Part D because you take nothing is the most expensive free decision in Medicare.
If you go without creditable drug coverage after you are first eligible, and later sign up, a late-enrollment penalty is added to your premium. It is calculated from how many months you went without — and once it attaches, you pay it for as long as you have Part D. It does not expire.
People who take no medications at 65 are exactly the people most likely to skip it, and exactly the people most likely to need medication by 72. A very inexpensive plan held continuously usually costs far less over twenty years than the penalty does.
If you have drug coverage through an employer, a union or the VA, it may already count as creditable — but check rather than assume, and keep the letter that says so.
How a drug plan charges you
Four things, and only one of them is the premium.
The advertisement quotes the first. Your actual annual cost is decided mostly by the other three.
02
The deductible
What you pay yourself before the plan contributes. Some plans have none; some apply it only to higher tiers. A plan with no deductible and a higher premium can easily be the cheaper one.
03
The formulary and its tiers
This is the one that matters. Each plan has its own list of covered drugs, sorted into tiers that cost you different amounts. Your medication being covered tells you nothing until you know its tier.
04
Your pharmacy
Plans have preferred pharmacies where your cost is lower, and standard ones where it is higher. The same prescription on the same plan can cost noticeably more at the shop two doors down.
Restrictions worth asking about. A plan may cover your drug but require the doctor to try a cheaper one first, ask for prior approval, or limit the quantity. These are not hidden — they are noted against each drug on the formulary — but nobody reads a formulary voluntarily, which is what we are for.
Why we review it annually
Drug plans change more than any other part of Medicare.
Formularies are rewritten every year. A medication on a low tier this year can move to a higher one in January, or leave the list altogether. Premiums and deductibles move too, and so do preferred pharmacy arrangements.
Meanwhile your own list changes — a new prescription in March, one discontinued in July. The plan that was right last autumn is frequently not the right one this autumn, and the only way to know is to run the list again.
- We re-run every client's list during Annual Enrollment, whether or not you ask
- Open the Annual Notice of Change when it arrives in September — it says what is changing
- Telephone us whenever a doctor adds something expensive, not only in the autumn
If the cost is a problem
Three kinds of help, and we will tell you about them unprompted.
None of these earns us anything. We raise them because people who qualify frequently do not know they do, and the amounts involved are not small.
Extra Help
A federal programme that substantially reduces drug plan premiums, deductibles and copays for people under certain income and resource limits. Administered by Social Security, and you can apply directly.
Apply through Social Security
State assistance
Medicare Savings Programs can pay your Part B premium and sometimes more, depending on income. Ohio, Kentucky and Indiana each run their own with different thresholds.
Varies by state
Manufacturer programmes
Many drug makers run patient assistance schemes for specific medications. Eligibility rules differ and they interact with Medicare in ways worth checking.
Drug by drug
Questions
Asked most about drug plans.
Four of about thirty. The rest are grouped by subject.
I take nothing. Do I really need a plan?
In almost every case, yes — and this is the advice people most often ignore and most often regret.
A minimal plan held continuously avoids a penalty that never goes away, and it means you are covered the week a doctor prescribes something unexpected. The arithmetic favours enrolling by a wide margin.
My drug is not on the plan's list. What now?
Three routes. Your doctor may prescribe a covered alternative; you may request a formulary exception with the doctor's support; or you may change plans at the next enrollment period.
If the drug is essential and no alternative works, the exception request is the one to pursue, and there are deadlines — telephone us and we will make sure you know them.
Can I have a drug plan alongside an Advantage plan?
Generally not, and attempting it can disenroll you from your Advantage plan and return you to Original Medicare without your intending it.
Most Advantage plans include drug coverage precisely so that you do not need a separate one. This is a genuinely dangerous mistake and it is why we ask what you already hold before anything else.
Is mail order cheaper?
Often for maintenance medications you take every day, particularly at ninety-day quantities. Rarely for anything you need this afternoon.
Most people end up using both, and the plan comparison should reflect how you actually fill things rather than an idealised version of it.
Read us your list and we will run it.
Twenty minutes on the telephone with your bottles in front of you is usually all it takes, and it is the single most valuable thing we do.