9 tips for choosing a Medicare prescription drug plan

My husband and I recently lost our health insurance after he was laid off from his job. We’re both over 65 and already had signed up for Medicare, but suddenly we had to consider picking a Medicare Part D plan for prescription drugs.

KFF reports that at least 53 million Americans have opted for Part D, a voluntary outpatient prescription drug plan, available by itself or as part of a Medicare Advantage managed-care program.

Unfortunately, as my husband and I quickly learned, Medicare Part D is complex and can come with pitfalls — most significantly, that plan terms and costs change every year. That means a plan with low premiums when you first choose it could become much less affordable the year after you enroll.

This is just one of the unsettling lessons I learned after taking a deep dive into some very boring details. Here’s what else I learned:

You may be overwhelmed by all the choices

Googling away, I found out there were more than two dozen prescription-drug plans offered for my ZIP code, involving a bewildering hodgepodge of premiums, deductibles, drug costs and co-pays. After picking a plan from one of the many online lists of recommendations, I ended up spending three hours on the phone to an insurance call center only to learn I would have to pay $2,945.30 a year for just one of the medications I take. The drug had been covered, at no extra charge, under my husband’s previous, employer-sponsored health plan.

Consider using a health insurance broker

Nearing desperation, I followed a friend’s recommendation and spoke with a health insurance broker.

Morgan DeMuth, a broker in Santa Cruz, California, walked me and my husband through our best options, signed us up for plans, gave us some tips on lowering costs and reminded us, repeatedly, to check in with her in a year to see whether we needed to change. The process of choosing a Part D plan is “enough to make anyone’s mind melt,” DeMuth told me.

Brokers are convenient. They work fast, keep up with changing rules and won’t cost you a dime, which helps explain why 1 in 3 Medicare beneficiaries rely on them, according to a study by the Commonwealth Fund.

But although our broker was great, not all of them are unbiased. They rely on insurers’ commissions, a practice some lawmakers are trying to change. Beware in particular of brokers who push Medicare Advantage plans, which pay them higher commissions. Some Medicare Advantage plans may not be your best option.

Timing is everything

Make sure to sign up during the yearly enrollment window, which began Oct. 15 and goes through Dec. 7, unless you qualify for a special exception, such as having moved between states or having lost previous insurance.

Don’t delay

Just don’t wait to sign up. The National Council on Aging says “the best time to sign up for Medicare Part D is when you start Medicare.” If you go more than 63 days after you first become eligible without what Medicare calls “creditable prescription drug coverage,” you’ll risk paying a penalty — a small percentage of your premium — that will be applied to your bills if you later sign up for Part D insurance. In other words, if you delay choosing drug coverage, you could end up paying more.

Consider alternatives to brokers

The federal government’s State Health Insurance Assistance Program (SHIP) provides a little-known alternative to brokers, offering one-on-one counseling, in person or by phone, to help Medicare beneficiaries and their caregivers make informed decisions. Every state has one, run by agencies that deal with aging or insurance. Unlike brokers, the state agencies aren’t tethered to commissions.

Another free support option is 1-800-MEDICARE. It’s managed by the federal Centers for Medicare and Medicaid Services and can answer questions and even sign you up for a plan. Medicare’s website also offers a tool comparing drug costs under different plans.

Ask for financial assistance

Under the Inflation Reduction Act, Part D out-of-pocket expenses for covered medications will be capped at $2,000 in 2025.

But if you’re struggling financially, ask SHIP or 1-800-MEDICARE whether you qualify for Extra Help, which is administered by Medicare and can substantially reduce your costs.

Get generic equivalents

Ask your health care provider about generic equivalents for brand-name prescriptions that aren’t covered by your plan. Alternatively, ask for a letter attesting to your need for a specific medication. I ended up doing this with one medication — and it worked.

Look into discount drug programs

If you’re struggling to get a particular drug covered, consider discount programs. Good Rx, the Mark Cuban Cost Plus Drug Company and CanadaDrugstore may offer surprising deals. Note that not all drugs are covered, and prices can change.

If in doubt, ask your doctor

The federal government requires Part D plans to offer at least two drugs in each therapeutic category, such as antibiotics or antidepressants. But that doesn’t mean they’ll cover the same drugs your doctor has prescribed.

When I complained to the Part D company call-center employee about the high cost of a stimulant prescribed for ADHD, she suggested I try alprazolam (for panic disorders), amoxapine (for depression) or armodafinil (for narcolepsy or sleep apnea) — none of which were recommended by my doctor. Don’t take this kind of advice without checking with your health provider because it may be ineffective or even harmful.