Medicare Part D Plan Finder instructions You can use these instructions to help you find the lowest cost Part D plans (both stand alone and Advantage plans) for the prescription drugs that you take. You may be able to complete your drug selection without using these detailed instructions (if you get stuck, you can turn to the instructions for that page). Part II begins on page 4 and covers what you should consider when choosing a plan. Part I: Entering your information 1. Begin at the Medicare web site at www.medicare.gov. Select the Compare Drug and Health Plans link, which takes you to the next page. 2. Page Heading Medicare Plan Finder. In the General Search section, enter your zip code and then click Find Plans, which takes you to the next page 3. Page Heading Step 1 of 4: Enter Information. Answer the first question by checking Original Medicare. Then answer the second question by checking I don t get any Extra Help, Then click Continue to Plan Results, which takes you to the next page. 4. Page Heading Step 2 of 4: Enter Your Drugs. If you don t take any prescription drugs, check the box to indicate that. Then the next page will be the list of plans in your zip code (first you ll get a pop up screen that asks you to verify that you don t want to enter drugs). The plan with the lowest premium is at the top of the list. If you do take prescription drugs, type in the name of your first drug. Or, if you ve already entered your drugs at an earlier session and you saved the Drug List ID number, you can enter that number in the Retrieve My Saved Drug List section at right. As you type a drug s name, you ll notice that after you ve typed in a few letters you ll see a dropdown list of the drugs whose names begin with the letters you ve entered so far. As you type in more letters, the list grows shorter. This feature can help you if you re not certain exactly how a drug s name is spelled (although you ll need to have the first few letters right). You ll also see that some drugs have more than one version perhaps a regular version and an extended release (XL or XR) version. You can choose the correct drug by selecting it from the dropdown list or you can finish typing the name. Then the Plan Finder shows a short list of all of the drugs with that name sometimes there are different versions or they are a combination of two drugs. Choose the + Add Drug button next to the one that you want. A pop up window appears asking you to choose the dosage, quantity, and frequency of refills. If none of the dosage quantities that are shown exactly match the quantities that you use, you can override the number that s shown. As an example, if you take a tablet 1
once every three days (10 times a month) and the lowest choice that s listed is 30 tablets a month, you can override the number 30 by typing the number 10. For refill frequency, choose the option you prefer. Later you ll be able to see the costs for 30 day refills and 90 day refills, and you can then decide which one you want to use. Once yu ve selected the dosage, quantity, and frequency, click Add drug and dosage. Another pop up window may appear that says A lower cost generic is available for the drug you selected. If this pop up window appears, you can choose the generic version or the brand name drug. If you choose the brand name version, the drug plan may request that your physician explain the reason you require the more expensive version. If you don t have any more drugs to enter, click My Drug List is Complete. If you do take more than one drug, type the name of the next drug that you take, again choosing the dosage, quantity and refill frequency. After you ve entered the names and dosages of all of your drugs, click My Drug List is Complete. 5. Page Heading Step 3 of 4: Select Your Pharmacies. Even if you use mail order refills, it s a good idea to select a local pharmacy for short term prescriptions. Also, by selecting a local pharmacy you can verify if it s in a plan s network and if it s a preferred pharmacy. Even if you are going use mail order refills, you will need to go to a network pharmacy for your retail refills in order to get the plan s pricing (if you go to a preferred pharmacy you may get even better pricing). This page lists the pharmacies that are within a certain radius of the center of your zip code. You can expand the radius by using the dropdown list at the top of the map, or you can click Search New Location or by Pharmacy Name to identify another zip code or to look up a specific pharmacy. You can also click on the button Show/Hide Pharmacy Map to help you see where the pharmacies in your zip code are located. Click on the Add Pharmacy link to choose the pharmacy you want to include (up to two pharmacies). After you ve chosen a pharmacy, click Continue to Plan Results, which takes you to the next page. 6. Page Heading Step 4 of 4: Refine Your Plan Results. Near the top of this page on the right side, you will see a Drug List ID number and Password Date. Write down this number and the date in case you later want to retrieve your list to add a drug and or change dosages. The center section of this page is the Summary of Your Search Results. Three types of plans are shown. You should check the box next to each type that you re interested in. You may want to see what your drug costs would be in more than one type. Here s a brief explanation of each type: 2
A) Prescription Drug Plans (with original Medicare). Also called stand alone drug plans, they can be combined with one of the following: 1) Medigap policies 2) Medicare Advantage plans that do not include drug coverage 3) Employer sponsored retiree plans that do not include creditable drug coverage B) Medicare Health Plans with drug coverage. These are Medicare Advantage plans that include Rx drug coverage. If you enroll in one of these plans, you will automatically get its drug coverage in other words, you cannot enroll in one of these plans and choose different drug coverage. C) Medicare Health Plans without drug coverage. If you enroll in one of these plans, you will also need to enroll in a stand alone prescription drug plan, which is explained in A) above. After you ve chosen the types of plans you wish to compare, select Continue to Plan Results, which takes you to the next page. 7. Page Heading Your Plan Results. The top section of this page shows Your Current Plan(s). If you checked Original Medicare on page 3, your current plan is shown as Original Medicare. Because Original Medicare does not cover drugs, the estimated annual costs are the retail costs you d pay without the Part D benefit. Ten plans are listed on this first page of Your Plan Results. If you want to see all of the plans at once, click on the View 50 link at the top of the list. Also, if you chose to see your drug costs in two types of Part D plans for example, stand alone and Medicare health plans with drug coverage then stand alone plans will be listed in one section and Medicare health plans (Advantage plans) in another. The list of plans is initially sorted by the first column, Estimated Annual Drug Costs. So, the first plan has the lowest estimated annual retail cost for your drugs, the second plan has the next lowest cost, and so on. These are the costs if you fill your prescriptions and refills at a local pharmacy. The costs for mail order prescriptions are shown below the retail costs. Usually mailorder will be less expensive. You can also sort the plans by their mail order costs by using the dropdown menu next to the Sort arrow near the top of this section. To choose another criterion for sorting, use the dropdown list to select the particular sorting criterion you want. As an example, you can select Overall Plan Rating as a sorting criterion and then click the Sort command to see the list of plans ranked by their quality ratings. 3
If you want to see more information about a particular plan s costs and coverage, click on the plan s name, which takes you to a page titled Your Plan Details. There are tabs at the top of this page that enable you to review various details of a plan s coverage. If the drug plan is part of an Advantage plan (here it s called a Medicare health plan), there s a Health plan benefits tab that you can click that to see a summary of the plan s medical coverage. As you evaluate plans drug costs, consider the suggestions in Part II below. You can view side by side comparisons of up to three plans (even if they are plans of different types). To do this, check the boxes next to the plans you want to compare. Then click the Compare Plans button, which takes you to the page that allows you to see the plans side by side, i.e., their premiums, estimated annual cost, and so forth. 8. Page Heading Your Plan Comparison (or Your Plan Details). When you choose to compare plans, this page shows side by side comparisons of their costs and benefits. At this point if you selected just one plan to evaluate (by clicking on the underlined plan name), the page s title is Your Plan Details. If you chose two or three plans, the page s title is Your Plan Comparison. Either way, the instructions in Part II may help you to evaluate plans. To see the medical coverage that s offered by Advantage plans, click on the Health Plan Benefits tab on the Your Plan Comparison or Your Plan Details page. You will see a summary of the plan s benefits as well as a link to a plan s web site. NOTE: You can go back and change information you entered earlier by choosing the page you want to go back to. Near the top of this page (and earlier pages as well), there s a trail showing the pages where you have already entered information. You can click on the page title that you d like to return to and change your information, i.e., you can change dosages, frequencies, add or subtract pharmacies, etc. Part II: What to consider in evaluating and choosing a plan Compare the costs for mail order refills and retail refills. Mail order usually is less expensive, although there are some exceptions. It s a good idea to sort the plans estimated annual costs both ways mail order and retail. Sometimes the fourth or fifth lowest cost plan using retail refills is the least expensive plan overall because of its low mail order costs. To see a plan s suggestions about substitute drugs that may reduce you costs, look at column # 4 (Drug Coverage, Drug Restrictions, and Other Programs). If a plan recommends a substitute drug, there will be a Lower your drug costs link in this column and row. Click on this link to see the recommended substitute drug and how much you ll save by switching to it. If there s no link, the plan does not have a recommended substitute for any of your drugs. Your physician would have to 4
prescribe any substitute medications. Substitute drugs are ones used to treat the same condition, e.g., high blood pressure, and cost less. Also, look at column #4 to see if plans have restrictions on any of your drugs. If a plan has one or more restrictions, you can see what they are by clicking Yes after the phrase Drug Restrictions. If you aren t sure how a restriction will apply to one or more of your drugs, you may need to contact the plan to clarify. A plan s toll free number is shown on the Your Plan Details page (you can simply click on the plan s name to get to this page). As an example, plans sometimes use a restriction known as step therapy, which means that the plans may want you to try a less expensive substitute drug and then if necessary step up to the more expensive drug. Usually these restrictions can be waived if your physician faxes a letter to the plan justifying your need for a specific drug. Still, it s a good idea to understand what the restrictions will be before you enroll. See if the plan that you re considering has a preferred pharmacy in your area. On the Your Plan Comparison or Your Plan Details page (see page 8 above), click on the Drug Costs & Coverage tab. Then scroll down to the section Pharmacy and Mail Order Information. When you expand that section (by clicking the + sign to the left of the section heading), it lists the pharmacies within a specified radius of the center of your zip code (you can expand this radius with the dropdown menu). If any pharmacy on the list is a preferred pharmacy, then it will have slightly lower copayments for retail prescriptions you fill through the plan. Consider a plan s quality ratings, which are based on Medicare surveys and other quality indicators. On the Your Plan Comparison or Your Plan Details page, select the tab that says Plan Ratings to view the quality ratings of each plan you re comparing. The highest rating is five stars and the lowest is one star. If possible, try to avoid plans with fewer than three stars. If two plans costs are similar, the quality ratings may help you decide which of the plans to enroll in. Some plans may be too new to have quality ratings. 5