Joanne: You may already be familiar with Part D prescription coverage, but how do you actually determine the right coverage for your unique needs? We're going to answer exactly that and more during today's episode. 

Cameron: But before we start, my name is Cameron Giardini, and together with my co-host Joanne Giardini Russell, we operate Giardini Medicare, which is an independent insurance agency based out of Southeast Michigan.

Although we are based in Michigan, we work virtually over the phone to directly help consumers in about 13 states find the right Medicare coverage for them. If we do not work in your state, we will connect you with another trusted independent agent who will be able to help you find the right coverage that you want.

We also now have a free online course available for you that you can register for, and you can learn more about many Medicare topics by going online to gmedcourse.com, which is gmedcourse.com. So, a brief overview of today's episode, we will give an overview of Medicare Part D. We will do an overview of when you can enroll in or change Part D coverage.

We will talk about resources and options to compare Part D coverage options. And probably most importantly, we will give a detailed process for how to choose a Part D plan. And then lastly, we will talk about how to enroll in Part D coverage and what you can expect after enrolling.

Joanne: Part D provides coverage for most outpatient prescriptions that you'll fill at a pharmacy. Part D is not a part of Original Medicare, which is Part A and Part B, but it's instead provided by private insurance companies that contract with Medicare to offer what are considered or referred to as Part D plans.

Although these Plans are provided by private companies, according to the Center for Medicare Advocacy, these companies are both regulated and subsidized by Medicare. To be eligible to have a Part D plan, you must be enrolled in Part A and or Part B of Medicare and be a resident of the county and the service area where a Part D plan is offered.

Medicare Advantage plans, which are sometimes referred to as Part C of Medicare. They also provide or include Part D prescription coverage, but the process of choosing a Medicare Advantage plan involves much more than just a prescription plan. So today's episode is not going to be focused on finding Medicare Advantage coverage, but luckily we do have another episode explicitly devoted to choosing a Medicare Advantage plan.

So who enrolls in a standalone Part D plan? Those people with Original Medicare that means people that have or do not have Medigap plans to go along with that, or people that are in a Medicare Advantage plan that are specifically referred to as an MSA or a PFF plan, that they don't include prescription drug coverage so that they would be enrolling into the standalone Part D plan.

Your choice of Part D coverage won't impact these other coverages. For example, your choice of Medigap coverage should not change how you approach finding a standalone Part D plan. So we often have to remind people that their Part D insurance company does not have to match their Medigap insurance company.

Cameron:

Now that we have the overview out of the way, when can you enroll or change Part D plans? This is always important to remember. So, the first opportunity for most people to enroll in Medicare Part D is during your IEP, which is your initial enrollment period. This enrollment period is a seven-month window that occurs three months before the month you turn 65, includes the month you turn 65, and extends for three months after the month you turn 65.

Of course, there are exceptions for a lot of things in Medicare. So, if your birth date is the first day of the month, your initial enrollment period will actually occur one month. The Part D Initial Enrollment Period occurs at the same time as your Part B, as in "boy" Initial Enrollment Period. Now after the Initial Enrollment Period, there are also Special Enrollment Periods, which are also known as SEPs.

You can enroll in or make changes to Part D coverage when certain events happen in your life. These events may give you access to a special enrollment period, and these SEPs will depend on many different factors. Still, some common SEPs for prescription drug coverage include leaving employer coverage, changing your residence, having low-income subsidies, or even government-declared disasters, and many more.

There are dozens of special enrollment periods that we will link to in the show notes. And now what we are approaching, or what most people know of, is the annual election period, which runs from October 15th to December 7th. This is known as AEP, sometimes mistakenly called open enrollment. But during this time, Medicare beneficiaries can enroll in Part D for the first time.

Or they can change from one Part D to another or from a Medicare Advantage plan to a Part D plan and Original Medicare. Now the new coverage, if you do this, will begin on January 1st of the following year, October 1st is when you can actually first see Part D details for the upcoming year. So make sure you check out Medicare.gov very soon. Regardless of the enrollment period you use for Part D coverage, the process of choosing a specific plan will be the same, and that is exactly what we will highlight very shortly, but we can't talk about the process without resources for where to compare Part D options. 

Joanne: One of the first resources is Medicare.gov. This is our recommended method that we're going to highlight here, but if you don't want to use the Medicare website, you can also call 1-800-Medicare, and a rep can actually do this with you over the phone and do your analysis for you. You can also call directly to an insurance company to understand their pricing to find a drug plan.

You can use their website or give them a call, but this is going to be tough because there are so many plans, and you're going to be calling so many different carriers. An example is in Michigan this year, there are nine other insurance companies that are offering a Part D plan. So you'll be making nine different phone calls.

You can call a broker. Just like us, we can compare all of the plans that are available in the market, and we can help you enroll in a plan at no added cost to you. Even if you find a Part D plan on your own, there's no downside to enrolling with a broker since we can help you with customer service or claims issues in the future.

There are also what are referred to as SHIP counselors. This is the State Health Insurance Assistance Program. This is a federally funded program with independent volunteers or staff workers that can help you compare Part D plans. Of course, we do recommend using a broker typically, but if you want to use SHIP as a second opinion, it is nice to have that option available to you.

Just like with brokers, make sure that the person you are taking advice from is experienced when comparing the plan options. But overall, all of these resources are using similar methods, and they're comparing the same plans with the same premiums and the same coverage. So don't think you're getting better coverage using one of these resources over the other.

Cameron: Yeah, and just a note to talk about when it comes to brokers, everyone will operate differently. But during AEP, because it's so crazy and we have thousands of Part D plans to review, we typically only assist our Medicare Supplement clients. So if you just want a Part D plan review, We're probably not going to be the best resource for that in the fall, but luckily we'll give you everything we know about how to find a Part D plan.

And we also have videos about the process that you can reference instead. So now we will get into that exact process for choosing a part D coverage option. So step one, gather a complete list of the prescription medications that you take. We're not talking about over-the-counter medications. But don't forget medications you don't refill often, but you may need to have filled at some point during the calendar year.

This is typically creams, inhalers, EpiPens, those kind of things. Step two, Once you have all your medications, our preferred method to finding a Part D plan is going directly to medicare.gov, which is the official Medicare website provided by the federal government. This is precisely what we use for our clients.

So, when you do this, you go online to medicare.gov. You can also see a video of this process by searching Giardini Medicare on YouTube, or you can find it in our online course for free at gmedcourse.com. Also, this is an optional step when using medicare.gov, but it is recommended you can log in, or you can create your own personal medicare.gov account to do this. 

This will let you update your list of medications and see Save your plan options for the future and save your medications for the future so you don't have to re-enter your full list of prescriptions whenever you want to compare plan options. Now step three, once you've done all this, is go to Medicare Plan Finder.

Which is on Medicare's website and then you click on "Find Plans Now "or the "Find Plans Now" button. This is going to be in the Find Health and Drug Plans section. This can change from month to month or even year to year. They kind of change how the website looks, but you're always looking for something that says find plans now or find health and drug plans, something along those lines.

Once you get to this section, you should see an option to put in the zip code of your primary residence, and then you will do that and click continue and then just choose you're looking for Part D coverage and click Find Plans. Now step four, determine if you qualify for one of the prescription assistance programs listed on the website.

The main one you might run into is a low-income subsidy known as LIS or extra help. If you know you qualify for these assistance programs, it's very important that you actually include this on the website because those programs can greatly reduce what you pay for medications and they can change the plan that might be right for you.

Now, if you don't receive financial help with prescriptions, or if you're unsure, you can just mark, no, you don't receive them, or I don't know. And then we move on to the next step. At this point, if you take prescription medications, you will want to select yes, you do take prescriptions, and you want to see drug cost to compare plans.

Now you are at arguably the most critical point of this whole plan search. This is where you enter all of the prescriptions that you want to compare the cost of. Make sure when you're doing this that you specify generic versus brand-name medications. For example, if you are actually taking the brand name Synthroid, make sure to note that instead of the more common generic of Levothyroxine.

Make sure you specify all of these things in detail because all of them will matter. Be careful, especially with tablets and capsules. Make sure you have the correct quantity of medications. Make sure if you have 50 milligrams of a medication, you put that. Or if it's 150 milligrams, you don't get those two confused, and you want to make sure things like liquids and creams are also the correct size.

These will all change your cost and potential plan options. Then you will also want to make sure you have the right frequency. This is also crucial. All of it's crucial, but this one, especially if you take 30 tablets per month. You will want to make sure you put that. Don't accidentally put 60 per month if you really take 30, because again, it all matters.

And then after you have this down, keep repeating the process of adding all of your prescriptions until you have accurately listed all of the medications you plan on needing during the calendar year or potentially needing during the calendar year. Once you've gone through your whole list of medications, it's also essential to think about if you have a unique situation when it comes to prescriptions.

And one thing that we see uniquely are things like injections that may be done at a doctor's office. So often, if you have an actual injection medication done at a physician's office, this is typically under Part B of Medicare, which is... Original Medicare Part B like boy. and That can impact your medication costs.

You probably don't have to put that medication in the plan finder tool, but of course, you'll want to consult with a broker or somebody knowledgeable to figure out if your prescription is actually under Part B or Part D. We also recommend talking to your doctor, whoever's actually billing that medication to see how it should be.

That way, you're not putting the wrong medication into the plan finder tool, which can also apply to Insulin you use or an insulin pump. So there are many situations where there are not actually part D Medications that you want to avoid having in the plan finder tool, and one more unique thing to note is what about these?

What if medications? And this happens a lot when people get caught up worrying about all of the possible medications that exist. There are thousands of medications covered by Part D plans. So instead, just focus on the medicines that you currently take or ones that your physicians have said you may need in the near future.

Remember, Part D plans can be changed and probably should be at least looked at every single year. So don't get too caught up in thinking, okay, what if I have high blood pressure that I'm not expecting or whatever it might be? If it's not realistically on the horizon, we can only do as much as we can.

And you just have to put in the medications that are most realistic for you. Now, the last couple of steps here. Step six, you should choose your pharmacy. Medicare.gov will allow you to compare the cost at up to five pharmacies at a time, so choose the ones in your area that you're actually willing to use. Part D plans, do have different preferred and standard pharmacies.

This can impact what you actually pay for prescriptions at the pharmacy. So when you select pharmacies, make sure you're actually doing the ones, again, that you are willing to use. If you don't want to choose one, find a plan that has that one as the best pharmacy, and then realize you're not actually going to use that pharmacy.

And you can also compare mail-order pharmacies' pricing. Last but not least at this point, Medicare.gov will show you all of the part D plans that are available in your zip code. And now it's time to choose the specific plan you want. Our recommendation is to make sure you are filtering by the lowest drug plus premium cost.

You should see a dropdown somewhere on the page right now. It's on the right-hand side of the screen, but again, you will want that to be set at the lowest drug plus premium cost plan. Premiums are just one small piece of the puzzle when it comes to choosing Part D, so it's essential to look at the overall cost.

Now that I have gone through the steps of how to actually process your medications through Medicare. gov to find the different Part D options, Joanne can talk about how you narrow down these options and choose a Part D plan.  

Joanne: Right, so when you're sorting your plan by that lowest drug plus premium cost, it's going to sort by the lowest overall cost for the year, which includes what you pay for the plan, which is called the monthly premium.

And what you're estimated to spend out of pocket for those medications that you've entered into your plan finder tool. This is going to include costs like your deductible, co-pays, and any co-insurance for that particular medication. Now, you're likely going to want to choose from one of the top few plans with the lowest overall cost.

There is a decent chance that you'll end up choosing the plan with the lowest overall cost, but there are some other things to consider. You're going to want to pay attention a little bit to star ratings, according to the Medicare Rights Center. The Part D plans they all receive star ratings from CMS, and these stars are based on customer service, member complaints, member experience with the plan, and the drug pricing, accuracy, and safety.

Plans are rated from one star, which means poor, to five stars, which means excellent. Star ratings should not be the main reason that you choose a plan, in our opinion. And really, you only want to be considering The stars after the cost. So if you're comparing a two-star plan to a four-star plan, it might be helpful, but don't get too caught up in that. 

Next, utilization methods are important and these include prior authorization, step therapy, and quantity limits. So we do cover these topics in other episodes but know that when you click on the plan details for any specific plan that you're looking at here, there's going to be a section that tells you if any of your prescriptions are subjected to these restrictions with the current plan that you're looking at.

Prior authorization and step therapy are typically the biggest hassles. So if you're comparing two plans that might be really similar in overall cost, you might want to lean towards the one with fewer restrictions on your medications. Now, out-of-pocket costs and how are your meds covered, things like that, you're going to want to double check to make sure that the pharmacy that you like is a preferred one with that plan and consider what medication tiers the deductibles do apply to and compare the co-pays of the plans.

For example, a Tier 3 medication might have a $40 co-pay with one plan, or it might have a 25% coinsurance with a different method. So quantify that, and see what that equals instead of the $40 copay. Also, if your medication is a specific tier with one plan, it does not mean it's going to necessarily be the same tier with another plan.

It could be a tier four with one plan or a tier three with another plan. So the whole point here is that they are not equal. For all of these things, you have to dive into a little bit of the details. So start with the lowest overall cost and then dive into some of these details that we're discussing.

Cameron (2): Yeah, and as Joanne said, it really does start with overall costs, and there is a good chance that probably one of the top three, we'll say, with the lowest overall out-of-pocket and premium combined, is going to be the option for you.

But you'll just want to make sure you're verifying that everything works based on what you're expecting, whether it's pharmacies or utilization like she just mentioned. So once you've selected a plan, how do you enroll, and what should you expect after that? Overall, even if you run a part D analysis on your own, using the methods we talked about today.

We still recommend getting a second opinion from a broker or at least using a broker to help you enroll in a Medicare Part D plan. Brokers run thousands of drug plan analyses throughout the years, so we can always provide some added insight you might not have thought of. When it comes to enrolling in a Part D plan, you'll probably notice that Medicare.gov even has an enrollment option right there when you do the plan options. 

But again, I already talked about it. We still recommend enrolling directly through a broker. This costs you nothing extra, and we can help with service issues down the road. We are paid commissions from insurance companies when enrolling you in a plan, so it does help us a little bit, and it can typically be done with a very quick and easy online application.

Now, keep in mind, like we've already mentioned, if it's open enrollment or if it's the annual election period and we're swamped, we're probably not going to enroll someone in only Part D coverage and pretty much always, we don't just write a part D plan for a client. We would also want to make sure we have a Medigap plan as your broker.

So this will vary from one to another, but we have made it the choice that we only do part D plans for clients if they also have Medigap plans with us. Brokers typically can't contract with all Part D plans, though. So if they can't help you enroll in a plan because they're not contracted, using Medicare.gov to enroll is also an easy online option that you can turn to. You can also call 1-800-MEDICARE directly to enroll if you prefer not to do it online and you want to talk to somebody, and you can even call the insurance company directly if you prefer to do so. Once you have enrolled in a Part D plan, you will receive plan documents and your Part D ID card about one to two weeks after your enrollment is approved.

Make sure you save these documents for reference. Also, if you are enrolling in Part D coverage for the first time after age 65, you might receive a Declaration of Part D. Prior prescription drug coverage. And this is a form you might receive. Complete this form to prevent being wrongfully assessed as a Part D penalty.

If you did, in fact, have proper previous prescription drug coverage, that is considered creditable. So, when it comes to finding Medicare Part D coverage, narrowing down options can seem overwhelming due to the sheer number of advertisements, opinions, and options you will encounter. In our opinion, understanding how to compare your Part D options and other Medicare options is one of the best ways you can empower yourself to confidently find a specific prescription drug plan.

As always, please leave us a review on your podcast app and subscribe so you can listen to future episodes. You can also find more content from us by going to YouTube or TikTok and searching Giardini Medicare. Last but not least, if you want to give us any feedback or send us any questions, you can send an email to info at gmedicareteam.com. So thank you, and have a great day.