Choosing the Right Prescription Drug Plan (PDP)

Step 1: Review Your Current Medications

• Make a list of all prescriptions you take regularly.
  • Note the dosage and frequency.
• Plans vary in which drugs they cover, so this is the most important starting point.

Step 2: Check the Plan’s Formulary

• Formulary = the list of drugs a plan covers.
• Confirm your medications are included and check which tier they fall under (generic, preferred brand, specialty).
• Lower-tier drugs usually cost less.

Step 3: Compare Costs

• Premiums: Monthly cost to keep the plan.
• Deductibles: Amount you pay before coverage begins.
• Copays/Coinsurance: What you pay for each prescription.
• Pharmacy Network: Some plans offer lower costs at preferred pharmacies.

Example: One plan may have a lower premium but higher copays, while another has a higher premium but lower total drug costs.

Step 4: Consider Coverage During All Phases

• Initial Coverage: Standard copays/coinsurance.
• Catastrophic Coverage: Once spending out-of-pocket reaches a set limit, costs drop significantly.

Step 5: Factor in Convenience

• Does the plan offer mail-order options for 90-day supplies?
• Are your local pharmacies in-network?
• Do you travel often and need coverage nationwide?

Step 6: Use Medicare’s Plan Finder Tool

• Medicare.gov offers a Plan Finder where you can enter your medications and compare plans side by side.
• Shows estimated annual costs, pharmacy options, and coverage details.

Consumer Takeaway

To choose the right prescription drug plan:

1. Start with your medication list.
2. Check each plan’s formulary and tiers.
3. Compare premiums, deductibles, and copays.
4. Review coverage phases.
5. Factor in convenience like pharmacy networks and mail-order.
6. Use Medicare’s Plan Finder for personalized comparisons.

This ensures you select a plan that balances cost, coverage, and convenience for your unique needs.

Get Help Enrolling

Connecting with a licensed agent can:

• Discuss Medicare options with you
• Help you understand the different Medicare components
• Compare plans to find the best fit for your budget and needs