Advice | Toni Says
Toni: I am turning 65 in July and am an insulin dependent diabetic. I take two insulins, which are rather expensive. I am concerned about the Part D Donut Hole, because I’ve seen my husband struggle with his current choice.
Last year, my husband, Steve, changed from his Medicare Supplement Plan with a separate Part D plan to a Medicare Advantage PPO plan. He was told that his doctors were in the plan and all of my husband’s heart meds were covered, which was not true.
He is now taking Xarelto for his heart and dives right into the Donut Hole. My question is how do I know which is the right Medicare Part D plan for me? Please guide me to find the best plan to fits my prescription drug needs and not financially break me. — Thanks, Margie from San Antonio
Great question, Margie: The first topic discussed at a Medicare consultation in the Toni Says office is which Medicare Part D prescription drug plan or plans cover all your prescriptions. Most do not realize that all medications are not covered under Medicare Part D formularies. When not covered, one must pay 100% out of pocket. Searching for the right Medicare Part D prescription drug plan that fits your needs is vital to proper Medicare planning.
Steps to do your own Medicare Part D prescriptions drug planning and find which plan best fits your prescription drug needs are below:
• Go to Medicare.gov.
• Click on the first green box that reads “Find health & drug plan.”
• Put in your zip code and click “Find Plan” box.
• Step 1 of 4: Enter information. Fill in the two boxes that read, “I don’t know what coverage I have,” “I don’t know” and “Yes” in the third.
• Step 2 of 4: Enter your drugs.
• Step 3 of 4: Select your pharmacies. You can select only two pharmacies.
• Step 4 of 4: Redefine your plan. For prescription drug plan only check the first box. For MAPD, click what Medicare Advantage Plan best fits your Medicare Prescription Drug needs. You can check both or all three boxes if you like.
• Finally: Your plan results. Click on the first boxes (maximum of three). Choose the first box, and then pick two more. Make sure you have chosen one with the Part D deductible and one enhanced with no deductible.
View your plan comparison. It will tell you the monthly premium, deductible, costs and if all drugs are covered on the plan you have picked.
Under section that reads, “Monthly Drug costs at Retail Pharmacy,” your monthly costs and if or when you go into the donut hole or into catastrophic coverage will appear.
Click on “View Drug Cost Summary.” This section tells the pharmacy price for each prescription with copay and cost when in coverage gap and catastrophic coverage. Pick which Medicare Part D plan best fits your needs, covers your prescriptions and the pharmacy you like.
Congratulations! You know how to find your own Medicare Part D plan!
If you are still confused and would like to discuss your specific Medicare circumstances either email info@tonisays.com or call 832-519-8664 and the Toni Says team can help you.