How do I shop and compare Part D Rx Prescription plans?

Medicare Plan Finder for 2020
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If you want us to shop for you... Send [email protected]  a copy of your Medicare ID card.

Medicare Part D Shopping Video 

BE CAREFUL OF THE SNAFU'S!!!

The “Total Yearly Cost of Care” does not provide personalized or transparent information. For example, when a consumer inputs or changes personal data, such as drug information, his or her total estimated costs do not change. This is not mathematically possible based on the plan benefits. Additionally, the tool does not share what is included in the total cost. As a result consumers will likely see the total cost and assume they are receiving a personalized and tailored estimate which may not be accurate.

The estimated total yearly cost of care is flawed. On a plan that has reduced benefits year over year, the expectation would be that the “estimated total yearly costs” would increase. However the tool is inaccurately estimating the consumer’s costs will decrease. It doesn’t make mathematical sense. For consumers on a fixed income and cost conscious, this could be detrimental to their situation.

Most supplemental benefits are not included in the total yearly cost of care. Over the past several years supplemental benefits have expanded and provided members with options that not only treat, but prevent illness and increase quality of life. We know the high value of benefits such as vision, dental and hearing to our consumers, and they are a key way we are partners in care with our members. Some of the benefits that are not included are:

Transportation lists copay but not number of rides.

Eyeglasses list copay but does not share if benefit covers frames, lenses or contacts.

Wellness Programs include a long list of possible items including fitness, nurse hotline, Personal Emergency Response and telehealth, that can’t be lumped into a single “covered” or “not covered” benefit.  Excerpt from UHC Agent Memo  * Forbes GAO 7.2019 Report

The four  main tools to shop and compare Medicare Part D Rx plans are:

See below for more details on how to work the tools.  If you prefer, you can email us [email protected] your medication list and we can do the comparisons for you.

Here’s the results of a hypothetical person with
diabetes taking 8 medications
.

Medicare.gov shows that the cost,  without any Part D coverage would be $17k.  If this person signed up for the Blue Shield Plan  their annual costs, including the Part D premium would be $8k.

If you are low income you might check out LIS – Low Income Subsidy – Extra Help to pay the Rx costs that are not covered.  LIS may also pay your Part D and Part B premiums and you might also qualify for Medi-Cal.

Scroll down  for definitions and instructions to use the Rx Plan Finder

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

Video

Understanding your Medicare Choices
Medi Gap vs Medicare Advantage

Topics

How to sign up for Parts A & B
Is  your test, service, or item covered?
Original Medicare Parts A & B
Medicare Advantage Plans & Part D Rx
Supplement Insurance (Medigap)
Low Income Help  LIS
Definitions


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My Drug List

The list of your prescription drugs previously entered on the site to help generate better estimates of annual and monthly costs under the available plans, and also see which plans cover your drugs.

The site doesn’t show pricing for over the counter drugs or diabetic supplies (e.g. test strips, lancets, needles). For more information, you may contact the plan.

Medicare Part D - Retrieval Code - Send us this # and we can review the results with you

Medicare Part D – Retrieval Code –
Send us   this # and we can review the results with you

dosage shop and compare

If you want us to enter your Rx, we need this kind of detail.

Medicare.Gov Glossary
for Shopping Tool 

Coinsurance

An amount you may be required to pay as your share of the cost for health care services or prescriptions after you pay any deductibles. Coinsurance is usually a percentage (for example, 20%).

Deductible

The amount you must pay for health care services or prescriptions each year, before your Medicare drug plan, your Medicare Health Plan, or your other insurance begins to pay. These amounts can change every year.

Dosage

The prescribed strength or amount of therapeutic ingredient(s) administered at prescribed intervals.

Drug Coverage

This tells you that a plan offers coverage of prescription drugs.

Drug Restrictions

The plan may have certain coverage restrictions (including quantity limits, prior authorization, and step therapy) on a prescription drug.

Example of Restrictions
Example of Restrictions

Estimated Annual Drug Costs

This is an estimate of the average amount you might expect to pay each year for your prescription drug coverage. This estimate includes the following costs, as applicable:

  • Monthly premiums
  • Annual deductible
  • Drug copayments/coinsurance
  • Drug costs not covered by prescription drug insurance

If you entered your drugs into the Medicare Plan Finder, then this estimate includes the cost of those drugs.

If you selected "I don’t take any drugs," then this amount includes only the cost of the monthly premiums that you would pay for the plan and it does not include any drug costs.

If you selected "I don’t want to add drugs now," then this estimate includes the average drug costs for people with Medicare and may differ depending on your age and health status.

Your expenses may be lower if you have limited income and resources.

Formulary

A list of prescription drugs covered by a prescription drug plan offering prescription drug benefits.

Monthly Premium

The periodic payment to Medicare, an insurance company, or a health care plan for health or prescription drug coverage. In a few cases, a note will say "Under Review" instead of a premium amount. This means Medicare and the company are still discussing the amount.

MTM Program

Medication Therapy Management (MTM) Programs

offer free services to eligible members of Medicare drug plans. These services help make sure that medications are working to improve their members' health. Members can talk with a pharmacist or other health professional and find out how to get the most benefit from their medications. Members can ask questions about costs, drug reactions, or other problems. Each member gets their own action plan and medication list after the discussion. These can be shared with their doctors or other health care providers. Members who take different medications for more than one health condition may contact their drug plan to see if they're eligible.  Humana * Medicare.gov

Star Ratings – Medicare Advantage

Medicare Glossary
Medicare Glossary

11 comments on “Shop & Compare Tools Part D Rx

  1. Plan d- I wand to know policy with best coverage as I know you can’t go up once you sign up, you can always lower or change your coverage

  2. I’d Appreciate your assistance recommending Part D plan available.

    Medications to be checked for 2020;

    zydelig 150mg(idelalisib);
    levothyroxine( 100mcg); generic crestor
    40mg(rovasustatin);
    gabapenten 100mg

      • Can you help find the most economic Part D plan for my Medigap, Least premium, deductible, copay and other fees?

        • Yes. See video at the very top of this page, our response just above and you can do the comparison on your own. If you want us to do it, just send a copy of your new Medicare Card, the one with secret #’s, not your Social Security # and we can do it.

          If you do it on your own, we represent Blue Cross, Blue Shield and United Health Care. Let us know and we can enroll you. If you want a company we don’t represent, you can enroll at Medicare.gov or contact that company and ask them to suggest agents in your area.

  3. Medicare‘s plan finder is being upgraded

    https://www.cms.gov/newsroom/press-releases/medicare-plan-finder-gets-upgrade-first-time-decade
    https://www.modernhealthcare.com/medicare/cms-refreshes-much-used-medicare-plan-finder-tool

    The changes include an improved mobile-friendly design

    inform users if a generic version of their prescription drug is available

    Users can also create a personalized drug list and view drug coverage across Medicare Part D plans. If someone is already a Medicare recipient, their recent claims data will be used to prefill a personalized drug list that they can modify based on recent changes in their medical care.

  4. I would like to know what the cost of tier 1 medications are.

    Specifically lisinopril hydrochlorothiazide and Atorvastatin.

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