How to find the best Medicare Prescription Part D Plan - 2023 Update

Hi, I'm Justin Lubino with Senior Advisors and we've created this video in the past to give an overview of how we choose the most cost-effective Part D

prescription

drug

plan

and use a tool found on the Medicare website and this video is now available. March

2023

and the last time we did this was August 2021 so there have been some

update

s with the tools so we want to do an

update

d video. The same functionality still applies, but there are just a few nuances that we wanted. To review in this video, we'll show you again how to use the Medicare Plan Finder to

find

the most cost-effective drug

plan

s.

The first thing you will do is go to the Medicare website, which is

medicare

.gov. and you click under search for health and drug plans, you'll click on search for plans now, then you'll have to enter your zip code and it'll select the plans that we're looking for, so I'm going to use for the purposes of this example. I'm just going to use the zip code of our office here in New Jersey and I'm going to select that I want to look at Part D plans and I'm going to click on Apply and then you're going to click on Start the The next question I'm going to ask you is do you get any additional assistance like Medicaid?

For this example, I am not receiving any additional help from any of these programs. Click Next and then it will ask if you want to enter your medication costs. Well, yes, that is. The purpose of this example is that we want to enter the medications to see what the drug plans will look like and then we have to enter the

prescription

, so we are going to do a couple of examples in this video. The first is a fairly simple low-cost situation where someone takes two medications, one is a generic for blood pressure and then a generic for cholesterol, so for blood pressure it's called lisinopril.

If you see, I wrote some letters and it starts filling out the different options so you don't have to know the exact spelling of the medications, it will kind of guide you through that process, then you click on add medication and you have to select the dosage so you can change to the correct dose you are currently taking. For the purposes of this example, I'm going to assume the default is 30 per month, which is basically you take one pill per day and then we're going to add that to my medication list and I'm going to add one more medication just for this first example and it's another um, this is the cholesterol medicine.

You can see I misspelled the letters there, but it still shows me the correct spelling below a tour for a statin which is the cholesterol medication and then again. We're going to select the dosage and frequency, we're just going to keep the defaults here and add them to my medication list, so for this

part

icular example, the individual is only taking these two medications and then we click Done to add medications . The next section is where you select your Pharmacy for that you can choose up to five pharmacies or four pharmacies and mail order I'm going to choose mail order and then we will choose a couple of local pharmacies and then a couple of national ones I will put the Walgreens and CBS are also there and then we'll click Done and by the way, here's a map where you can see different pharmacies and locations of where they are.

Once you click Done, the tool is doing all the work. us and is calculating the total total expenditure for the year for each of those. There are 24 different drug plans available in this area. Most states have about 24 25 and what you're doing now is calculating the total cost, which is the premium plus the cost of your drugs for each of those 24 different plans and then automatically sorting the plans based on total cost lowest, so we're not just looking for the lowest premium, we're not just looking for the lowest drug cost, we're looking for that. lowest total cost to

find

which will be most cost-effective, so in this example the plan that was most cost-effective is called the wellness care value script.

The premium here is nine dollars and 30 cents a month, that's what you pay for the insurance. It has a deductible of $505, but once we look into the details we will see that this only applies to higher tier drugs and will not affect these drugs. Sorry, yes, these medications will not be affected by that deductible. Now here's the key number that we're really most concerned about, which is the total cost of the drug and the premium for the rest of the year, so it's always the rest of the year and we're looking at the first of the following month, so we're on March 23 right now, so from April 1,

2023

until the end of December, what will be the total cost of the drug and the premium for this?

In this example, it's 83.70 for this plan, so that includes the nine dollars a month and then As you'll see, there are no drug costs because these are tier one generics for this plant, but if you scroll down to the next one, you'll see that this Next plan has a lower premium of 6.80, but the total cost for the year includes the premium. and includes the deductible if applicable and includes drug costs, everything in that total is higher, so even though the premium is lower, your total cost would be higher with this second plan and if you continue scrolling down the list, you will see that number.

It keeps going up because the total cost is higher as you go through these plans, so the point is that we're not just looking for the lowest premium, we're always trying to find the most cost effective based on that total total cost for the year. Now, the other thing I want to show is that there is a lot of great information here. If we go into the details of the plan, we will see more information about the plan again. It will give us that monthly premium. It shows us the total cost of the medication for the year. so if we go to a pharmacy we can see it's zero dollars for the year, if we use mail order it's also zero dollars for the year and we're going to go into more detail on how they get those numbers.

We scroll down the page here before we get there, although there is more information about these pharmacies that you can see. We put the five pharmacy options. This shows us which ones will be preferred, which ones are only within the network, which ones are outside. out-of-network if we select out-of-network, but preferred pharmacies are usually where you'll get lower cost sharing for that

part

icular plan, so the next section here shows an annual drug cost per pharmacy, so this is where Let's see that for those preferred pharmacies it is zero, there is no medication cost for these medications.

When we do the second example, we'll add some expensive medications so you can see where it shows us the cost of those expensive medications. This also shows If you go to one of these other pharmacies that are in-network, you will pay a higher cost for your drugs because it is not a preferred pharmacy, so the next section shows us the estimated total cost of the drug and premium for the year again, this number. Here, 8370 is the number that made us select this plan. This is the number that moved this plan to the top of the list because this is the lowest total cost for all the plans that exist for this particular example of medications correctly, it also shows if and when you will meet your deductible your deductible and then if you're going to enter the coverage gap, which is also known as the coverage gap, it will let you know what month you're going to hit that coverage gap and then what month you're going to get out of the coverage gap if you are going to go out and get catastrophic coverage.

Now these different phases are explained in other videos that I've created that explain how Medicare Part D works, so I'm not going to go into that here, but we have another video out there, it's about 10 to 15 minutes long, that explains all of these different phases. Within Part D, the deductible, coverage gap, and catastrophic level is as well, so the next section breaks down the monthly drug cost so you can see it again. This is a bit of a silly example because it's zeroes throughout when we look at the next example where we have some expensive medications.

We'll look at how it changes by month as far as drug cost goes, then we'll go down to the drug prices for each of those pharmacies, so this is where you'll see the monthly cost and the retail cost. You can see the cost before the deductible and the cost after. deductible if you hit that coverage gap or donut hole, what you have to pay and then if you hit the catastrophic level, what you're going to pay again for those drugs, all of that is explained in another video and then it's just repeated. which for each of those five different pharmacies, so you can see all that information, it repeats, then you have a section here that gives you even more information about the medications about the different tiers for the particular plan, what you're going to pay um, this is five. actually, in a six-tier plan, you can look at one, two, three, four, five, six, and depending on the tier of your drugs, you see what you're going to pay as far as copayment or coinsurance for those drugs, so there's more information about the drugs, if there is any type of prior authorization or quantity limit for these drugs, you will see that or step therapy that will be defined in this other drug information section and you will be able to see if there is a quantity limit; you can click on it to See, the most you'll be able to get for this particular medication is 30 every 30 days, which is the right amount for this individual anyway, so it doesn't affect him.

If for that quantity limit you are foreign, then you just have a repeat of the medications that were entered so you can see the correct ones, you know, the correct dosages and frequency were entered for the medications, then there is a section here with which People just get confused, but these are Part B drugs that are not covered by the Part D drug plan. Well, clearly that makes sense because Part B drugs are covered by Part B as in the child, not by Part D as in the drugs, so that's it, it basically says that if you have chemotherapy drugs that are covered by Part B as in the child, they would be covered by your your Medicare Part B if you have a Medicare supplement that typically pays the other 20 for those Part B drugs and then at the end of this report you'll see the star ratings for these plans, and we've been doing this for a long time.

A long time and I've never really seen a five star medication plan. Most years it is three stars. It's kind of a range for these three, three and a half. You can find one, one or two plans in a state that have four stars, but. And then there are also some lower ones that you have to be careful with, but you don't know to say that there will be a great Part D drug plan that will have phenomenal service and everything will always be fine. We're never going to have a problem, uh, it doesn't really exist, unfortunately, um, so if you're in that three and a half star range, um, that's what we've seen, it's better, sometimes there's a four-star plan. stars, but we rarely see a five-star Part D drug plan and it breaks down the ratings even further for you using additional metrics, so you can see what those ratings are, so there's lots and lots of information here in this tool is A very powerful tool, again, this is what we use to choose the most cost-effective drug plans for our clients.

It is also available to everyone on the Medicare website. I'm going to go back now and do one more example with a little bit more. Expensive medications to give you an idea of ​​what that looks like, so we'll keep those other two medications that we entered earlier and then add an expensive heart medication called Xarelto. I'm just going to keep the default. dosage of this medication and then we will also add an expensive eye drop called zidra and again we will just keep the default dosage and amount for that medication and then click on finish adding the medications that we are going to take.

Back to the pharmacy page, we're not going to make any changes here, we're keeping the same pharmacies and now it's being recalculated, so all 24 drug plans are being looked at again to calculate the total cost for the year, the premium plus the cost of the drug and then sort the list by lowest drug and premium cost. This is just a coincidence that this plan appears as number one on the list again. Certainly, this will not always be the case. It will just depend on the medications you enter, but here it is. The key here is to see how much that number jumped, that total cost for the year instead of being 80-something dollars, which was really just the plan premium.

Now we are almost at three thousand dollars for our total cost that includes the premium. includes deductible, includes drug costs, everything on that one is the

best

, it's the lowest total, so if we scroll down to the next one on the list, you can see this one is a little bit higher, 26 .91 and then goes to 2 800 28.52. and so on, if we go down to the bottom of the first page, we are above 3200 andIf we go to the last page we will see big differences in the cost here, see this one, over nine thousand. all of these are over nine thousand, most likely one of those medications is not covered in these plants and it doesn't mean that they are never going to be good plans, but for this particular situation, you know, these plans that show a very high cost would certainly not be an effective plan for this individual.

Just scrolling through this is the second page, you can see a lot of these in those higher ranges. Well, but it's all very specific to the medications you're taking. We are going now. Go back to that first page now and I'm going to go back to the first plan again to go to the details of the plan, just to give you an idea of ​​what it looks like now that we have some medications, some expensive medications, so here we show you all four. of those drugs are covered and the total cost for the year will now be just for the drugs, not including the premium, it will be about 2600 at the pharmacy, a little more than that if you do mail order and if you scroll back down the list of information again, we have the pharmacies again, now we have the breakdown of the annual drug costs by pharmacy, so now we can see that for these expensive drugs, Xarelto and zidra, you can see that this is the total cost that you are going to pay for these again.

This is just a model if you don't get these medications every month. You are not paying this total, but this is a model that is projected if you get these medications every month. pay about fifteen hundred dollars for Xarelto for the rest of the year and about $1,100 for drug the coverage gap and catastrophic coverage for those drugs, so if we scroll down to the next section where it shows the total cost of the drug and the premium for the year, that's the total number on the first page again, that's how we choose . The plan based on the lowest total break of the year shows us when we are going to reach the deductible which is April is the following in this case because we add those expensive medications the first time you filled them as a family member or the zidra that We will have to meet the 505 deductible, so let's say we start over.

This report was done in March, so it looks like the first of the following month is April 1, so we will meet that deductible in April in this example and then it shows when you will reach the coverage gap, which will also be called The Donut Hole here, but it will be July, again, based on the start date of April, April, May, June, July, the fourth month of this For example, if you fill those drugs every month, you will hit that coverage gap in July and then you will move out of the coverage gap to the catastrophic level in December, in this example where your costs will drop back down to five percent, the next section here again shows the estimated total monthly drug costs by month, so you can see which is not fixed, you can't just take the total drug cost for the year and divide it by 12 and when you have expensive drugs.

It's going to jump all over the place because of the deductible that first month, that's where you have to pay 593 because you have the deductible of 505 and you also have copays for your medications. The next few months, May and June, you're going to pay 88 for your medications, which are the copays or the initial coverage level costs, so you're hitting that coverage gap in July. You can see it's like a partial month, you're not getting the full month of the coverage gap, but just once. you get to August now you're in the coverage gap, the coverage gap where you have to pay 25 of the cost of your medications, which is that number 347, approximately per month, it will decrease once you get to December because of that We're reaching coverage catastrophic and again we have other videos that explain these phases, but this is just the report that breaks it down so you can see by month what your estimated cost would be if you had those expensive medications and then you can break it down even further. as we saw above by pharmacy by month, this shows you at CVS for each of those medications.

You know what the total retail cost is. You can see Zitra is over 700 a month and Xarelto is over 600 a month retail, so those costs. are what get you into the coverage gap and why you end up having to pay that 25 after four months of the year, the cost before the deductible is really if you haven't met the 505 deductible, you have to pay the full cost of these drugs higher tier until it reaches $505, then you will have a forty-four dollar co-pay, which is the cost after deductible for those expensive drugs, the other two drugs still have a zero co-pay for low-cost drugs, and then, once you reach the coverage gap is where you have to pay 25 percent of the cost of these drugs, so the Xarelto is 157 per month and the zidra is 191 per month and finally once you get out of the coverage gap catastrophic coverage, you are basically paying. five percent for those expensive drugs and for the generics here it's two dollars for each uh per month so you can check these numbers and look back at the table if you look here and see that 349 36 that's once you reach that coverage Gap and you have a full month, you can see that from August to November you are in that coverage.

Gap and the initial coverage level was $88, so you can see that here too while you're only in it for a few months. you're at that initial coverage level, where you're paying that 88 and then it repeats for each of the pharmacies. You can see how if it differs at all, I'm not going to go through each one of them here, but it's the same concept, um and then more information about medications will be the same as what we looked at before, but I really just want to give those two examples so you can. see an economic example and then a more complicated one where you have the coverage gap. and the catastrophic there too, so I hope you found this video useful.

If you liked it, like the video. Please provide any comments or questions below so more people can see the video. You can also contact us through the contact information below. video if you have any more questions thank you and I hope you have a great rest of the day, take care