The Truth About the \"Best\" Medicare Part D Plans

If you're looking for a shortcut to the "best" Medicare Part D plan, you're going to be disappointed. We'll give it to you straight: there is no universal best plan. The plan your neighbor loves might cost you thousands of dollars out of pocket if you take different medications.

When you choose the Traditional Medicare path - which means you're relying on Original Medicare (Parts A and B) for your hospital and medical coverage - you need a standalone Part D plan to cover your prescription drugs. This is a crucial component of the Traditional path, not an afterthought.

The best Part D plan is simply the one that covers your specific list of medications at the lowest total out-of-pocket cost for the year. That includes the monthly premium, the annual deductible, and the copays or coinsurance you'll pay at the pharmacy counter.

Insurance companies want you to focus on the monthly premium because it's easy to understand. They'll advertise a $0 or $10 premium plan and hope you don't look at the fine print. But your dollars are votes, and you shouldn't hand them over without doing the math. A low-premium plan with terrible coverage for your specific drugs is a bad deal. Protect what you've earned by looking at the total cost, not just the sticker price.

To find the right plan, you need to look at three things: the formulary, the tier structure, and the pharmacy network.

First, the formulary is the list of drugs the plan covers. If your medication isn't on the formulary, you'll pay full price. Second, every plan divides its covered drugs into tiers. Tier 1 is usually preferred generics with the lowest copays, while Tier 4 or 5 includes expensive specialty drugs with high coinsurance. Finally, plans have preferred pharmacy networks. If you go to an out-of-network pharmacy, you'll pay more.

You also need to understand the coverage phases, including the deductible, the initial coverage phase, the coverage gap (often called the donut hole), and catastrophic coverage. The rules change every year, and the plan that was best for you last year might not be the best one this year.

You don't have to figure this out alone. We're on your side of the table, and we'll walk you through every option. We can run your specific medication list through our comparison tools to find the plan that actually makes sense for your situation.