The Med Diva

An insider's guide to Medicare Part D and more

Picking a Medicare Part D Plan is not that confusing, but it can be aggravating!

Picking a part D plan can be aggravatingYesterday, I came across an article on the Healthcare Savvy blog titled “Picking a Medicare Part D Plan Is Not as Confusing as They Say.” The author made some valid arguments based on statistics, but I just had to reply to let him know that I beg to differ with him on several points.   

According to the author, although Medicare beneficiaries have numerous Part D plans from which to choose, it really isn’t that difficult to pick a plan once you break them down into three categories:

  • Plans for those who don’t take any drugs
  • Plans for those who take only a few lower-cost generic drugs
  • Plans for those who take numerous or expensive drugs, and therefore end up in the Coverage Gap

 I’m not going to get into the details here (you can read the article for more info if you’d like), but the problem with this theory is that it only looks at one part of the equation, and that is the cost. Yes, if you just look at overall costs it’s fairly simple to pick a Part D plan. The thing is, if you really want to get the most value for your Medicare dollar—and receive high-quality customer service that leaves you feeling satisfied rather than frustrated—there are a few other things to consider.  For example:

  • You should always make sure your drugs are covered under the plan’s List of Covered Drugs (Formulary).  The Medicare Plan Finder can help you find plans that cover your drugs, but I do know for a fact that for someone who takes multiple medications, it can be very time-consuming (and not always easy) to find a plan that will cover them all.
  • Although the author of said article disagrees with me on this point, I always tell people to choose a plan with a high star rating from the Centers for Medicare & Medicaid Services. The star ratings measure everything from customer service issues such as call wait times to clinical issues such as adherence rates for members taking diabetes and hypertension medications. Starting in 2015, CMS will begin terminating the contracts of Part D and Part C sponsors that fail to receive at least a 3-star (average) rating for 3 years in a row—so if you choose a low-rated plan, you may end up having to switch plans in two years. To me, that’s a hassle.
  • If you take a lot of medications—or several expensive medications—you may want to find a plan that can help you lower your prescription drug costs and delay entering the Coverage Gap. For example, plans with home delivery can often save you a lot of money if you choose that option. Unfortunately, not all plans have a home delivery service.

So no, it really isn’t difficult or confusing to pick a Part D plan during Medicare Open Enrollment, especially with online tools like the Medicare Plan Finder. But if you’ve been in a plan that meets all your needs for years and find out you have to leave because of low star ratings—or because the plan decides to raise prices or remove some of your drugs from the formulary—than it becomes an aggravation. Plain and simple.

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