What to Look for When Comparing Plans - National Multiple Sclerosis Society

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What to Look for When Comparing Plans

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Overview

Medicare promises a choice of at least two plans for every area in the country. In addition to your basic choice between a "stand-alone" prescription drug plan (PDP) or a Medicare Advantage plan that includes prescription drug coverage (MAPD), there are important differences between plans to consider. Once you enroll in a plan, you will generally be locked in until the next Open Enrollment Period (October 15-December 7 of each year).

What medications are you taking?

Before you begin comparing plans, list drugs you are currently taking and the dosages, which you can always double check with your doctor or pharmacist. It’s also helpful to have your Medicare card with you. This allows you to do a personalized search for prescription drug plans in your area on the Medicare Plan Finder website and automatically save the list of medications once they have been entered. 

If you do not have access to the Internet, or simply want help from someone more familiar with this research, you can get help over the phone. Visit our resources page for information about who to call for help.

What plans are offered in your area?

To choose the best plan for your needs, carefully review all the plans available in your area. Check each plan to determine:

  • the premium, annual deductible and, if possible, gap coverage
  • if all your prescription medications are covered on the plan's list of drugs, called the “formulary”
  • what formulary tier (if any) your medications are on and the cost implications for you
  • if “prior-authorization” is required by the plan before you can fill prescriptions for any of your medications
  • if any of your medications have quantity limits and how that could affect you
  • if the plan requires step therapy for a medication (requiring you to try a different medication before they will agree to cover the medication you would like to take)
  • if the plan's pharmacies are conveniently located or if they have a mail order option

You can do side by side comparisons of different plans on the Medicare website.

If a medication you need is not included on any available plan’s formulary, or if plans only cover a generic equivalent, ask your doctor's office for help. Never guess about substituting your prescription medications because you find one that sounds like your medication. It is strongly recommended that you call the prescription drug plans directly to verify that your medications are actually covered at the price stated on the Medicare website before committing to enrollment with a plan.

It is important to note that medications given intravenously or by infusion, including Tysabri®, Novantrone, and any type of IV steroid, are not billed under Medicare Part D. These are billed through Medicare Part B because they require the services of a physician.

Medicare Rights Center

Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare, and a collaborative partner of the National MS Society.

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Centers for Medicare and Medicaid Services

Medicare is a government entitlement program administered by Centers for Medicare and Medicaid Services (CMS). Visit Medicare’s official website.

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