Step 5. Pick a Plan

What types of plans will cover drugs?

If you want Medicare prescription drug coverage, you will need to choose the type of plan you would like.  There are two types to choose from:

  1. Medicare Prescription Drug Plans, or PDPs
    • Medicare Prescription Drug Plans are separate, free-standing insurance plans that will cover prescription drugs only.
    • You would pick a Medicare Prescription Drug Plan if you have either:
      • Original Medicare (Medicare Part A or B)
      • A Medicare Cost Plan or one of the Private Fee-For-Service (PFFS) Plans that does not include drug coverage.
  2. Medicare Advantage plans with Prescription Drug coverage, or MA-PDs
    • Medicare Advantage plans are health plans that cover both your medical care and prescription drugs.
    • The major types of Medicare Advantage plans are:
      • Health Maintenance Organizations, or HMOs.
      • Preferred Provider Organizations, or PPOs.
      • Private Fee-for-Service plans, or PFFS.
      • Special Needs Plans, or SNPs (which only serve certain groups of people with Medicare)
    • If you  choose one of these plans, you will have to use hospitals and doctors in the Medicare Advantage plan’s network to save the most money. You will pay higher costs if you use providers outside the network.
    • There may be Medicare Advantage plans in your region that do not offer prescription drug coverage. Make sure you choose a plan with prescription drug coverage if you need it.

How do I pick a plan to cover my drugs?

Most people will pick a plan based on:

  • What drugs they use.
  • What pharmacy they want to use.
  • How much the plan costs.
  • Whether they want a plan that covers prescription drugs only (a standalone Medicare Prescription Drug Plan or PDP) or a Medicare Advantage plan with both medical benefits and prescription drug coverage (a Medicare Advantage Prescription Drug plan or MA-PD).

How will I sort through all the plans?

There are many plans to choose from in your area. Medicare.gov has a tool to help you narrow your search.  It is called the Medicare.gov Prescription Drug Plan Finder. You will be able to enter your drugs and the name of your pharmacy.  Then, the tool will tell you which plans are available and how much each one will cost.  You will be able to compare the different plans and decide which one is right for you.

Look for plans that charge the least for your drugs. The  Plan Finder can tell you how much you will pay each year.  Look in the column called “Total Annual Drug Cost.” This annual cost includes your cost for the plan’s monthly premium and your share of the cost for your drugs.

Choose two or three plans, then look on the Medicare.gov Plan Finder for more information. Look for the answers to these questions:

  • Are there any limits for my drugs?  For example, can I buy as much as I need at a time?  Can I buy the drug I want, or do I have to try another drug like it first?  Does the plan have to approve drugs before I buy them?
  • Can I buy my drugs through the mail?  If so, how much will I save?
  • How can I get my drugs if I travel a lot?  What does it cost to use a drug store that is not in my network?

You can also get help from your State Health Insurance Assistance Program (SHIP). SHIPs offer free, objective advice to help people with Medicare explore their options.

Aon Hewitt Navigators® is a Medicare insurance brokerage service recommended by NCOA because it meets rigorous Standards of Excellence established by NCOA. You may be eligible for personal one-on-one assistance in selecting and enrolling in health coverage. All of the services are provided at no cost to consumers. Check to see if you are eligible.

NEXT: Step 6. Learn when and how to join

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