How to Choose a Medicare Prescription Plan: 6 Steps

When it comes to Medicare Part D, what you don’t know can definitely cost you. Many people make the same few avoidable mistakes, like choosing a plan based only on its low monthly premium or assuming their medications will automatically be covered. These simple errors can lead to high costs and a lot of frustration at the pharmacy counter. The good news is that you can easily sidestep these common pitfalls. This guide will shine a light on the most frequent mistakes and show you exactly how to avoid them. Think of it as your inside track to making a smarter decision, giving you the knowledge you need for how to choose a Medicare prescription plan correctly the first time.

Key Takeaways

• Calculate your total annual cost, not just the premium: A plan’s true expense includes the monthly premium, the annual deductible, and the copayments for your specific drugs. A low premium can be misleading if other costs are high.
• Always check the plan’s drug list (formulary): Each plan covers a different set of medications. Before enrolling, confirm all your prescriptions are on the list to avoid paying full price at the pharmacy.
• Enroll on time to avoid lifelong penalties: Your first opportunity to sign up for a drug plan is during your Initial Enrollment Period. Missing this seven-month window can result in a permanent penalty added to your monthly premium.

What Is Medicare Part D and What Does It Cover?

Think of Medicare Part D as your prescription drug plan. It’s an optional part of Medicare designed to help you manage the costs of your medications. Since Original Medicare (Part A and Part B) doesn’t typically cover the prescriptions you take at home, a Part D plan can be a crucial piece of your health care puzzle, protecting you from high out-of-pocket drug expenses.

These plans are offered by private insurance companies that are approved by Medicare. While every Part D plan must provide a standard level of coverage set by Medicare, the specific drugs covered and the costs can vary quite a bit from one plan to another. This is why it’s so important to compare your options carefully. You can get this prescription coverage either by adding a separate drug plan to your Original Medicare or by choosing a comprehensive Medicare Plan that includes it from the start. We’ll explore both of these paths to help you decide which one makes the most sense for your health needs and budget.

Standalone Plans vs. Medicare Advantage: What’s the Difference?

You have two main paths to get prescription coverage. The first option is to enroll in a standalone Medicare Prescription Drug Plan (Part D). This type of plan works alongside your Original Medicare (Part A and Part B). It’s a great choice if you’re happy with your Original Medicare benefits but just need to add coverage for your medications.

The second option is to choose a Medicare Advantage Plan (Part C) that includes drug coverage, often called an MA-PD plan. These are all-in-one plans that bundle your hospital insurance (Part A), medical insurance (Part B), and prescription drug coverage (Part D) together. Many also offer extra benefits like dental and vision.

Are You Eligible for Part D?

The good news is that if you’re enrolled in Medicare, you’re likely eligible for Part D. To join a Medicare drug plan, you must have either Medicare Part A (Hospital Insurance) or Medicare Part B (Medical Insurance). You also need to live in the service area of the plan you want to join.

Your Medicare eligibility for Part A or B is the key that opens the door to Part D. If you have both, you’re all set. If you only have one, you can still enroll. This simple requirement ensures that nearly everyone on Medicare has access to prescription drug coverage when they need it.

How Much Will Medicare Part D Cost?

When you start looking at prescription drug coverage, the first question on your mind is likely about the cost. It’s helpful to know that the price tag isn’t just one single number. Instead, your total out-of-pocket expenses for a Part D plan are made up of a few different parts that work together. You’ll typically have a monthly premium, an annual deductible, and then copayments or coinsurance for each prescription you fill.

Understanding how these pieces fit together is the key to finding a plan that truly works for your budget and your health needs. Some Medicare plans bundle this coverage, while others offer it as a standalone option. Each private insurance company that offers these plans sets its own costs, so you’ll see a lot of variation. Let’s break down each of these costs so you can feel confident when comparing your options and avoid any surprises at the pharmacy counter.

Your Monthly Premium

Think of your monthly premium as your subscription fee for the plan. It’s a fixed amount you pay each month to the insurance company to keep your coverage active. While you might not have a premium for Medicare Part A, UnitedHealthcare notes that “if you have Part D coverage, you may have a premium for that as well.” This amount can vary quite a bit from one plan to another. Some plans might have a very low or even a $0 premium, while others are higher. It’s also worth noting that if your income is above a certain level, you may have to pay a bit more for your Part D premium.

The Annual Deductible

The annual deductible is the amount you must pay out-of-pocket for your prescriptions before your plan starts to share the costs. Each year, Medicare sets a maximum amount that plans can charge for their deductible. For example, AARP points out that while the maximum deductible was $505 in 2023, it increased to $545 in 2024. However, it’s important to remember that “some plans don’t have a deductible” at all. A plan with a $0 deductible will start covering your medication costs right away, though it might have a higher monthly premium in exchange. You’ll want to weigh this initial expense against the plan’s other costs.

Copayments and Coinsurance

Once you’ve met your deductible, you’ll start sharing the cost of your medications with your plan. This is where copayments and coinsurance come in. A copayment is a fixed dollar amount you pay for a prescription, like $10. Coinsurance is a percentage of the drug’s cost, such as 25%. As AARP explains, “Plans usually have different price levels (tiers) for medicines.” This means your copay or coinsurance will depend on which tier your drug is in. Generally, generic drugs are in the lowest tiers and cost the least, while brand-name and specialty drugs are in higher, more expensive tiers.

Why to Look Beyond the Premium at Total Annual Costs

It’s easy to get drawn to a plan with a very low monthly premium, but that number doesn’t tell the whole story. As AARP wisely advises, “Don’t just look at the monthly fee (premium). A plan with a low premium might have high costs for your medicines.” A plan could have a $15 monthly premium but a high deductible and place your most-needed medication on an expensive tier. To get a true sense of what you’ll spend, you need to estimate your total annual costs. You can do this by adding up 12 months of premiums, the full annual deductible, and the estimated copayments for all your prescriptions. Using a tool to view plans and enroll can help you compare these total costs side-by-side.

What Is a Drug Formulary?

Think of a drug formulary as a plan’s approved medication list. It’s a comprehensive list of all the prescription drugs covered by a specific Medicare Part D or Medicare Advantage plan. Each insurance company creates its own formulary, which is why you might find that a drug covered by one plan isn’t covered by another. These lists aren’t set in stone; they can change from year to year as new drugs become available, drug prices change, or a plan’s contracts with manufacturers are updated.

This is why it’s so important to review a plan’s formulary every single year during the Annual Open Enrollment Period, even if you’re happy with your current coverage. A medication that is covered this year might be moved to a more expensive tier or removed from the list entirely next year. Taking a few minutes to check the formulary ensures the medications you rely on will still be covered in the coming year, helping you avoid unexpected costs at the pharmacy. Understanding the formulary is a key part of managing your health care budget and making an informed decision about your coverage.

Understanding Formulary Tiers

Most drug plans group their covered medications into different levels, called tiers. These tiers determine your out-of-pocket cost for a prescription. A drug in a lower tier will generally cost you less than a drug in a higher tier. For example, a typical plan might have four or five tiers. Tier 1 is often for preferred generic drugs and has the lowest copayment. As you move up the tiers, you’ll find non-preferred generics, preferred brand-name drugs, non-preferred brand-name drugs, and finally, specialty drugs, which have the highest cost-sharing. When you compare plans, pay close attention to which tier your specific medications fall into, as this will directly impact your monthly expenses.

How to Check if Your Medications Are Covered

The most important step in choosing a plan is confirming that all your prescriptions are on its formulary. If a drug you take isn’t on the list, you’ll likely have to pay the full retail price for it. The easiest way to do this is by using an online comparison tool. When you enter your list of medications, the tool will cross-reference it with the formularies of available plans in your area. This helps you quickly see which plans cover your drugs and what your estimated costs will be. You can use our free online portal to view plans and enroll while also checking which ones cover your specific prescriptions.

What to Do if a Drug Isn’t on the List

Don’t panic if you find a plan you like but discover one of your medications isn’t on its formulary. You still have options. First, check the formulary to see if it covers a similar drug. Plans often cover different medications that treat the same condition. The next, and most critical, step is to talk to your doctor. Show them the list of covered alternatives and ask if one of them would be a safe and effective substitute for you. Never switch medications without your doctor’s explicit approval. If no alternative will work, you may need to find a different plan that does cover your exact prescription.

A Quick Look at Prior Authorization and Step Therapy

Sometimes, even when a drug is on the formulary, the plan has special rules you must follow before it will cover the cost. Two common rules are prior authorization and step therapy. Prior authorization means your doctor must get approval from the plan before you can fill the prescription. Step therapy requires you to try a more affordable, similar drug first. If that drug doesn’t work for you, the plan will then cover the more expensive one. You can find out if your medications have these requirements by reviewing the details of the Medicare plans you’re considering.

How Pharmacy Networks Affect Your Costs

When you choose a Medicare Part D plan, you’re also choosing a pharmacy network. This is simply the group of pharmacies that has an agreement with your plan to provide medications at a set price. Sticking to pharmacies within this network is one of the easiest ways to keep your prescription costs down. Going to an out-of-network pharmacy often means you’ll pay the full price for your medication, which can get expensive fast.

Most networks include major chains, local independent pharmacies, and mail-order services. However, not all in-network pharmacies are created equal when it comes to your out-of-pocket costs. Understanding the difference can save you a lot of money throughout the year.

Preferred vs. Standard Pharmacies

Think of a plan’s pharmacy network as having two tiers: preferred and standard. Many Medicare plans contract with certain pharmacies to offer lower prices. These are called “preferred pharmacies,” and filling your prescriptions there will give you the lowest copayments. Other pharmacies in the network are considered “standard.” You can still use them, but your out-of-pocket costs will likely be higher than at a preferred location. Before you enroll, it’s a great idea to check if your regular pharmacy is listed as preferred or standard so you can anticipate your costs.

The Convenience of Mail-Order Pharmacies

If you take medication for a chronic condition, using a mail-order pharmacy can offer both savings and convenience. Many plans provide lower costs for prescriptions you get through their designated mail-order service, especially for a 90-day supply. This is a great option for managing your medication needs without having to make frequent trips to the pharmacy. Getting your prescriptions delivered directly to your home simplifies your routine and often helps your budget, making it a popular choice for many people on Medicare.

How to Confirm Your Pharmacy Is In-Network

You don’t have to guess whether your pharmacy is covered. The easiest way to check is by using the official Medicare Plan Finder tool on Medicare.gov. As you compare different Part D plans, the tool allows you to add your favorite pharmacies to see if they are in-network. It will also show you if they are a preferred or standard option for that specific plan. Taking a few moments to verify this information is a crucial step that helps you choose a plan that truly works for your life and your wallet.

Your 6-Point Checklist for Choosing a Prescription Plan

Choosing a Medicare prescription drug plan can feel like a monumental task. With so many options, each with its own costs and rules, it’s easy to feel overwhelmed. But finding the right coverage doesn’t have to be complicated. The key is to break the process down into simple, manageable steps. This checklist is designed to do just that. Think of it as your personal roadmap to comparing plans and making a choice that fits your health needs and your budget.

By following these six steps, you can move forward with clarity and confidence. We’ll walk through everything from gathering your personal information to understanding the fine print of each plan. This isn’t about finding just any plan; it’s about finding the one that works best for you. Taking the time to do this research now can save you a significant amount of money and stress throughout the year. When you’re ready, you can use the official site to view plans and enroll or talk to one of our licensed agents for personalized guidance. Let’s get started.

1. List Your Current Prescriptions

Before you can compare any plans, you need a clear picture of your own medication needs. Grab a pen and paper or open a new note on your computer and make a complete list of every prescription you take. Be sure to include the exact name of the drug (brand or generic), the dosage, and how often you take it. This list is the single most important tool you’ll have. When you compare plans, you will use this information to check each plan’s formulary, which is its list of covered drugs. Without an accurate list, you’re just guessing at which plan will serve you best.

2. Calculate Total Annual Costs

The monthly premium is the first number most people see, but it tells only a small part of the story. A plan with a low premium might have a high deductible or expensive copayments for your specific medications. To get a true sense of what you’ll spend, you need to look at the total potential cost for the year. This includes the monthly premiums plus your estimated out-of-pocket expenses for deductibles, copays, and coinsurance. The Medicare Plan Finder tool helps with this calculation, giving you a much more realistic idea of what each plan will actually cost you.

3. Review the Drug Formulary

Once you have your medication list, your next step is to check the formulary for any plan you’re considering. Does the plan cover all the medicines you take? Pay close attention to which “tier” your drugs fall into, as this determines your copayment. If a critical medication isn’t on the formulary, you will likely have to pay the full price out-of-pocket. Don’t assume a plan that worked for you last year will be the same this year, as formularies can change annually. Always double-check your coverage during the Open Enrollment Period.

4. Check the Pharmacy Network

Where you fill your prescriptions can have a big impact on your costs. Most Part D plans have a network of pharmacies, and many of those networks include “preferred” pharmacies where your copayments will be lower. Before you enroll, confirm that your favorite local pharmacy is in the plan’s network. If it’s not, you’ll have to decide if you’re willing to switch pharmacies to save money. Also, check if the plan offers a mail-order pharmacy option. This can be a convenient and cost-effective way to get a 90-day supply of your maintenance medications delivered right to your door.

5. Compare Plan Star Ratings

Medicare uses a Star Rating system to measure the quality and performance of plans, and it’s a fantastic tool for comparing your options. Each plan gets a rating from one to five stars, with five being the highest. These ratings are based on member experiences, customer service, and how well the plan manages care. While cost and coverage are essential, a high star rating can indicate a smoother, more positive experience for you as a member. You can easily see and compare these ratings on the Medicare Plan Finder tool.

6. Assess Customer Support

Finally, consider the level of support you’ll receive. When you have a question about a claim or need help with a coverage issue, you want to know you can get a clear and helpful answer. Some plans are known for excellent customer service, while others can be difficult to work with. Reading reviews and looking at the star ratings for customer service can provide some insight. This is also where working with a licensed insurance agent can be a huge help. We can share our experience with different carriers and help you find a plan with a reputation for supporting its members.

Using the Medicare Plan Finder Tool

Think of Medicare’s official Plan Finder tool as your personal comparison shopper for prescription drug coverage. This free, unbiased resource on Medicare.gov is one of the most powerful tools at your disposal. It allows you to enter your specific medications and preferred pharmacy to see exactly how different plans will work for you in the real world. Instead of guessing, you can get a personalized estimate of your total annual costs, including premiums, deductibles, and copays.

While the tool is incredibly detailed, it can sometimes present a lot of information at once. Let’s walk through how to use it effectively so you can feel confident in the results. If you ever feel stuck, remember that our team is here to help you make sense of your options and view plans to enroll.

A Step-by-Step Guide to Comparing Plans

Getting a truly personalized comparison is straightforward when you follow a few key steps. First, make a complete list of your prescription drugs, including the exact name and dosage. Next, head to the official Medicare Plan Finder website. You’ll be prompted to enter your zip code, your list of medications, and the pharmacy you prefer to use.

Once you’ve entered your information, the tool does the heavy lifting. It will show you a list of available plans and, most importantly, estimate your total yearly drug costs for each one. Pay close attention to this number. A plan with a low monthly premium might have a high deductible or expensive copays for your specific drugs, making it more costly overall.

How to Understand Your Comparison Results

After the Plan Finder generates your list of plans, you’ll want to look closely at a few key details to make an informed choice. The tool displays a star rating (from 1 to 5 stars) for each plan. These ratings reflect member satisfaction and the quality of care, covering areas like customer service and pricing accuracy. A higher star rating is generally a good sign.

Next, click on a plan to review its formulary, which is the list of covered drugs. Confirm that all your current medications are on the list. If a drug isn’t covered, you’ll likely pay the full price for it. Also, check the pharmacy details to see if your local pharmacy is in the plan’s network and whether it’s a “preferred” location, which often means lower copays.

When Can You Enroll In or Change Your Part D Plan?

Choosing a prescription drug plan isn’t a one-and-done decision. Your health needs and the plans available can change over time, so it’s important to know when you can sign up or make adjustments. Medicare has specific windows for enrollment, and understanding them is key to getting the right coverage and avoiding potential penalties. Think of these periods as your opportunities to ensure your plan continues to work for you.

Whether you’re just turning 65 or have been on Medicare for years, these timelines apply to everyone. The main times you can enroll or switch plans are during your Initial Enrollment Period when you first become eligible, the Annual Open Enrollment Period held each fall, and under special circumstances that grant you a Special Enrollment Period. Missing these windows, especially your first one, can lead to a life-long late enrollment penalty. We’ll walk through each of these Medicare enrollment periods so you can feel confident about when and how to act.

Your Initial Enrollment Period

Your Initial Enrollment Period, or IEP, is your first and best opportunity to sign up for Medicare Part D. This seven-month window begins three months before the month you turn 65, includes your birthday month, and ends three months after. For example, if your birthday is in June, your IEP runs from March 1 to September 30.

During this time, you can enroll in a standalone Part D plan to go with Original Medicare or choose a Medicare Advantage plan that includes prescription drug coverage. Signing up during your IEP helps you avoid the Part D late enrollment penalty, which can be a permanent addition to your monthly premium. Even if you don’t currently take any prescriptions, it’s wise to consider enrolling in a low-premium plan to secure your spot and prevent future fees.

The Annual Open Enrollment Period

The Annual Open Enrollment Period (AEP) is your yearly chance to review and change your Medicare coverage. This period runs from October 15 to December 7. During AEP, you can switch from one Part D plan to another, move from Original Medicare to a Medicare Advantage plan, or change from a Medicare Advantage plan back to Original Medicare and add a Part D plan.

This is the perfect time to reassess if your current plan still meets your needs. Perhaps your prescriptions have changed, or your plan altered its formulary or costs. Any changes you make during AEP will take effect on January 1 of the next year. You can use this window to view plans and enroll in one that better fits your budget and health requirements for the year ahead.

Special Enrollment Periods for Life Changes

Life is full of changes, and sometimes those changes affect your health care needs. Medicare recognizes this by offering Special Enrollment Periods, or SEPs. An SEP allows you to change your Part D or Medicare Advantage plan outside of the usual enrollment windows. You might qualify for an SEP if you experience a specific life event, such as moving to a new address that isn’t in your current plan’s service area.

Other qualifying events include losing other creditable prescription drug coverage (like from an employer), moving into or out of a long-term care facility, or becoming eligible for Medicaid. These periods give you a limited time to adjust your Medicare plans to match your new circumstances, ensuring you don’t have a gap in coverage.

How to Avoid Late Enrollment Penalties

The Part D late enrollment penalty is an amount added to your monthly premium for as long as you have prescription drug coverage. You may have to pay this penalty if, after your Initial Enrollment Period is over, you go 63 consecutive days or more without a Medicare Part D plan or other creditable prescription drug coverage (like from an employer or VA benefits).

The best way to avoid this penalty is to sign up for Part D when you first become eligible. If you don’t take any medications, you can still enroll in a plan with a very low monthly premium to protect yourself from future penalties. If you delay applying for Medicare Part D, the penalty amount is calculated based on how long you went without coverage, and it can add up over time.

Could You Get Extra Help Paying for Prescriptions?

Prescription drug costs can be a significant part of your budget, but you might not have to cover them all on your own. If you have limited income and resources, a federal program could provide valuable assistance with your medication expenses. Understanding how this program works is the first step toward lowering your out-of-pocket costs and making your health care more affordable. It’s a resource worth looking into, as the savings can make a real difference each year.

What Is the Extra Help Program?

The Extra Help program is designed to help people pay for their Medicare prescription drug coverage (Part D). Also known as the Part D Low-Income Subsidy (LIS), this program can significantly lower your expenses for monthly premiums, annual deductibles, and prescription copayments. For those who qualify, the program is estimated to be worth around $6,200 a year, making it a powerful tool for managing your budget. If you meet certain income and resource limits, you could get help with your Medicare plans and make essential medications more accessible.

How to Check Your Eligibility and Apply

Finding out if you qualify for Extra Help is straightforward, and you can apply at any time. The best way to start is by visiting the Social Security Administration (SSA) website, where you can complete the application online. You don’t even need to be enrolled in a Part D plan yet to apply. Your Medicare eligibility for this program is based on your income and resources, which have specific limits that are updated each year. If you qualify, you’ll receive a notice in the mail explaining your level of assistance. As an added benefit, you won’t face a Part D late enrollment penalty as long as you have Extra Help.

Common Part D Mistakes (and How to Avoid Them)

Choosing a prescription drug plan can feel like a puzzle, but it gets a lot easier when you know what to look out for. Many people make the same few mistakes when they first enroll. The good news is that they are all completely avoidable. Let’s walk through the most common slip-ups so you can feel confident in your decision and find a plan that truly works for you.

Mistake #1: Assuming All Prescriptions Are Covered

It’s a common belief that if a plan covers prescriptions, it covers all of them. Unfortunately, that’s not the case. Each Part D plan has its own list of covered drugs, called a formulary. A medication you rely on might be covered by one plan but not another. Before you commit, it’s essential to check the plan’s formulary to confirm your specific prescriptions are included. This single step can save you from unexpected costs and headaches down the road. You can view plans and compare their formularies to find the right match for your needs.

Mistake #2: Choosing a Plan Based on Premium Alone

A low monthly premium can be tempting, but it rarely tells the whole story. A plan with a $20 premium might seem like a great deal until you realize it has a high deductible or expensive copayments for your specific medications. It’s important to look at the total picture, including the deductible, copays, and coinsurance, to estimate your total annual cost. Sometimes, a plan with a slightly higher premium can actually save you money over the year if its other costs are lower. Understanding all the components of Medicare plans helps you make a smarter financial choice.

Mistake #3: Forgetting to Review Your Plan Each Year

Once you’ve picked a plan, it’s easy to set it and forget it. However, Part D plans can change their costs and coverage every single year. The formulary might change, your favorite pharmacy could leave the network, or your premium could go up. That’s why it’s so important to review your plan during the Annual Open Enrollment Period. This is your chance to make sure your current plan is still the best fit and to switch if it’s not. Taking a little time to compare your options each fall ensures your coverage keeps up with your health needs.

Mistake #4: Missing Your Enrollment Deadline

Medicare has specific windows of time when you can sign up for a prescription drug plan. If you’re new to Medicare, you have a seven-month Initial Enrollment Period. Missing this deadline can lead to a lifelong late enrollment penalty and a gap in your prescription coverage. There are other specific Medicare enrollment periods for making changes, but your first opportunity is the most important one to catch. Being aware of these dates is key to starting your coverage on the right foot and avoiding unnecessary fees.

Ready to Find Your Plan? We Can Help.

Choosing the right Medicare prescription plan can feel like a huge task, but you don’t have to sort through it all by yourself. Think of us as your personal guide. We’re here to help you understand your options and find a plan that truly fits your life and budget.

Before you view plans and enroll, it helps to have a clear picture of your needs. Start by making a simple list of all the medications you take. This is your starting point for finding a plan that covers what you need without any surprises. Once you have your list, you can use it to compare different formularies, which are just the lists of drugs covered by each plan.

Next, look beyond the monthly premium. A low premium might seem appealing, but high deductibles or copayments can quickly add up. We can help you calculate the total potential costs so you know what to expect for the year. It’s also important to remember that Medicare plans can change annually, so reviewing your coverage each year is a smart move to ensure it still meets your needs.

Feeling a little lost? That’s completely normal, and it’s why we’re here. Our licensed insurance agents can walk you through every step, from checking your drug list to comparing total costs and confirming your pharmacy is in-network. Let us handle the details so you can feel confident in your choice. When you’re ready, you can schedule a no-cost consultation to get personalized advice.

Related Articles

• Medicare Prescription Drug Plans Part D
• Medicare Prescription Drug Coverage – My Senior Health Plan
• Medicare Advantage Plans
• Medicare FAQs

Frequently Asked Questions

Do I really need a Part D plan if I don’t take any prescriptions right now? This is a great question, and it’s smart to think ahead. Even if you don’t need medications today, enrolling in a low-premium Part D plan when you first become eligible is often a wise move. It protects you from the lifelong late enrollment penalty that you could face if you decide you need a plan later on. Think of it as affordable insurance for your future self, ensuring you have coverage in place and won’t pay extra for it down the road.

Is a plan with a $0 premium always the cheapest option? Not necessarily. While a $0 premium is certainly appealing, it doesn’t show you the full picture of your potential costs. A plan with no monthly premium might have a higher annual deductible or place the medications you need in a more expensive cost-sharing tier. To find the most budget-friendly option, you should always compare the total estimated annual costs, which include the premium, deductible, and your specific prescription copayments combined.

What should I do if my doctor prescribes a new drug that isn’t on my plan’s list? First, don’t worry, you have a few options. The best first step is to talk with your doctor. Show them your plan’s formulary (its list of covered drugs) and ask if there is a similar, covered medication that would work just as well for you. If there isn’t a suitable alternative, you or your doctor can ask your plan for a formulary exception to have the drug covered.

My plan was great this year. Do I really need to review it again during Open Enrollment? Yes, it’s a very good idea to do a quick review each year. Insurance companies can change a plan’s formulary, costs, and pharmacy network from one year to the next. A medication that is covered now might not be next year, or your favorite pharmacy could move out of the preferred network. Taking a few minutes to confirm your plan still fits your needs during the fall Open Enrollment period ensures you won’t face any unwelcome surprises in January.

How is a standalone Part D plan different from getting drug coverage through a Medicare Advantage plan? The main difference is how the coverage is structured. A standalone Part D plan is a separate policy you add to your Original Medicare (Part A and Part B) benefits. It’s a great choice if you are happy with Original Medicare and just need to add prescription coverage. A Medicare Advantage plan (Part C), on the other hand, is an all-in-one alternative that bundles your Part A, Part B, and usually your Part D prescription benefits into a single plan.