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Exploring Your Part D Coverage

During open enrollment, you may have signed up for a new Part D plan, or maybe you stuck with the same drug coverage you’ve had for years. Either way, making sure you know some basic information about your plan will help guarantee that you are getting your medications at the lowest possible cost. So at the beginning of this year, take some time to sit down and review the elements of your Part D coverage.

The first thing you want to look at when reviewing your Medicare Part D plan is its formulary, or the list of medications it covers. You can look up your plans formulary by going to your insurance provider’s website or search plans in your area through Medicare’s website at

The next thing you’ll want to think about is how much you will be paying for your medications. There are a number of different factors that can influence the total amount you will need to pay out of pocket for your prescriptions. Below is a list of some of the basic elements that can impact your costs and what each term means:

Premium– This is the amount you pay for your insurance coverage plan. You usually pay this amount on a monthly basis, but can sometimes pay quarterly or annually.

Deductible- The deductible is the amount you are required to pay annually before your plan will begin to cover your expenses. The deductible you have to meet does not include the payments you made towards your premium. Once you meet your deductible, your plan will begin to cover your expenses but you may still need to pay cost-sharing in the form of a copay or coinsurance (more on that below). A high deductible can make your out of pocket costs each year much more significant, so make sure you factor that into your cost calculations.

Copay– A copay is the fixed amount you’ll have to pay towards your medications each time you get them filled.

Coinsurance– Coinsurance means that rather than play a flat rate for your medications, you will pay a percentage of the medication costs. If one or more of your medications requires coinsurance that could significantly impact your costs.

After you have figured out what drugs your Medicare Part D plan covers and what costs you will be expected to pay, the next thing you want to look at is what pharmacies are covered under your plan. Some plans have a preferred relationship with certain pharmacies, which may make obtaining your medications less expensive.

Take some time this month to look over your coverage and explore the additional resources on this site to further understand your Part D plan. If you are not on a 5 star rated plan and find for any reason your plan is not working for you, you can change to a 5 star plan at any time and not have to wait until the next open enrollment season.

If you have any questions contact your Medicare SHIIP Counselor at your local Area Agency on Aging. You can also call Medicare all day, any day except Federal holidays at 1-800-633-4227.