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Medicare Q&A: Choosing the right prescription drug plan

Choosing the right prescription drug plan can be a headache when in the midst of enrolling for Medicare. Medicare enrollment runs from Oct. 15-Dec. 7. There are resources available to help enrollees choose which plan is right for them.
by Jaclyn Cosgrove Published: November 13, 2012

Over the next three weeks, adults 65 and older will make several decisions as they sign up for Medicare.

The Medicare open enrollment deadline is Dec. 7. Many adults are currently considering which prescription drug plan is right for them. There are two ways to get drug coverage, a Medicare prescription drug plan, known as Part D, or a Medicare Advantage Plan, known as Part C.

Pritpal Virdee, the CEO of Smart Insurance, answered questions about what enrollees should consider when signing up for a prescription drug plan.

How can prescription drug plans change from year to year?

“Everything changes every year, and that's where you, as a beneficiary who is looking to enroll in one of those plans, have to look at what your out-of-pocket cost is going to be,” Virdee said.

Every year, an insurance company submits its latest prescription drug plan to the government for inspection. Companies will regularly change their deductibles, premiums, copays and drugs they cover.

If you're in an existing plan, your insurance company should have sent you information on any changes it made. If you did not receive that information, you should contact the company and ask about any changes you should expect.

What are some common mistakes people usually make when signing up?

“Say I'm a senior who's been used to going to Joe's Corner Pharmacy for 40 years — make sure that Joe's pharmacy is in the network for the plan you're signing into because if he's not, he's going to have a higher copay for you for the same drug you could get at a Walgreens or another store cheaper,” Virdee said.

Virdee said adults should find out not only about a plan's premiums and deductibles, but also what the copay will be on generic and nongeneric drugs.

Some companies offer a $0 copay with certain “preferred” generic drugs or “preferred” brand-name drugs. If you're taking three or four prescriptions, it's important to know how much the companies cover.

Also, more companies are partnering with pharmacies and building a network of preferred pharmacies. It's important to find out if the plan you're choosing has your pharmacy in its network, Virdee said.

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by Jaclyn Cosgrove
Medical and Health Reporter
Jaclyn Cosgrove writes about health, public policy and medicine in Oklahoma, among other topics. She is an Oklahoma State University graduate. Jaclyn grew up in the southeast region of the state and enjoys writing about rural Oklahoma. She is...
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