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Part D: How to
evaluate a plan
Ask yourself these
two key questions:
1.Does it have the drugs you need? Plans differ considerably on
which drugs they cover. Look at each plan's formulary, or list of
covered medicines, to see if the ones you take (brands and dosages)
are on it, what co-payment is required (many plans break drugs into
three cost tiers) and whether you'll need additional authorization
from your doc.
It's crucial to do all this even if you're just re-enrolling, as
many formularies have changed.
2. Does it give you enough coverage? Ask your pharmacist(s) for a
list of the prescriptions you've filled so far this year and their
current selling price - not your co-pay - then calculate your bill
for the year. (Remember those total drug costs? They are figured not
by what you lay out but by the retail price.)
If the total is near or above $2,400, where the doughnut hole
begins, consider a plan that offers gap coverage. If your drug costs
are well below $2,400 and you're fairly healthy, you should be okay
with a more basic, less costly plan.
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