How to Evaluate Your Medicare Part D Drug Coverage
When it comes to Medicare, one area that deserves an annual check-up is your prescription drug coverage. Many retirees don’t realize that while Medicare Supplement (Medigap) policies generally lock you into your original carrier and plan, Medicare Part D drug plans are different. You can review and change your Part D plan every year during the Annual Enrollment Period (October 15 – December 7). Any changes you make will take effect on January 1. That flexibility is valuable — but only if you take the time to compare your options.
The same is true for Medicare Advantage (also known as Part C) plans, which often include prescription drug coverage. These plans should also be reviewed and possibly switched annually, since their benefits, networks, and pricing can change from year to year. If you opted for Medicare Advantage instead of original Medicare (parts A & B with a supplement), then it’s even more critical that you review your plan annually to ensure it’s still a good fit as insurerers frequently shift or play games with pricing and coverages.
Why You Should Review Annually
Part D and Advantage drug plans are not static. Each year:
Formularies change: Drugs may move from one “tier” to another, affecting your cost.
Premiums and deductibles adjust: What was affordable last year may no longer be the best value.
Your prescriptions may change: New medications or dosage changes can alter which plan works best for you.
As a result, sticking with last year’s plan can end up costing you more than necessary.
Matching the Plan to Your Prescriptions
The best way to evaluate your options is to start with your medication list:
If most of your prescriptions are generic
A low-premium plan often makes sense, since generics typically fall into Tier 1 or Tier 2 with low copays.If you take brand-name or specialty drugs
A more comprehensive plan may lower your total annual costs, even if the monthly premium is higher. Better formulary coverage or lower copays for expensive drugs can make a big difference.
Remember: it’s not just about the cheapest monthly premium. The real goal is to minimize your total yearly expense — premiums plus deductibles, copays, and coinsurance.
Other Key Considerations
Preferred Pharmacies: Many plans offer lower copays at “preferred” pharmacies. Switching where you fill prescriptions can sometimes save as much as changing plans.
The Coverage Gap (“Donut Hole”): Medicare Part D has a stage where you may pay a higher share of costs once total drug expenses reach a certain threshold. Plans differ in how they manage this, so it matters if you use costly medications.
Extra Help: If you have limited income, you may qualify for the federal “Extra Help” program, which can significantly reduce premiums and out-of-pocket costs.
Common Mistakes to Avoid: Don’t pick a plan based solely on premium, forget to update your prescription list when comparing, or assume your current plan is still the best choice.
How to Compare Plans
The most reliable resource is the official Medicare Plan Finder at Medicare.gov. It allows you to:
Enter your ZIP code.
Select your preferred pharmacies.
Add your medications.
View side-by-side comparisons of available plans, including estimated annual costs and star quality ratings.
Importantly, the Medicare Plan Finder lets you compare both stand-alone Part D drug plans and Medicare Advantage (Part C) plans with drug coverage. In either case, evaluating your options annually ensures your coverage still fits your needs.
For personalized guidance, you can also contact your state’s SHIP (State Health Insurance Assistance Program) or call 1-800-MEDICARE.
The Bottom Line
Evaluating your Part D coverage each year is one of the simplest ways to keep your health care costs under control. Take an hour during open enrollment to run your prescriptions through the Medicare Plan Finder and compare your options.
Whether you have a stand-alone Part D plan or drug coverage through a Medicare Advantage plan, annual review during open enrollment is the key to keeping costs manageable and coverage aligned with your needs.
Clients can also reach out to us for guidance and referral to local experts during open enrollment to ensure they have the optimal coverage for their situation.
