| Wed, Oct 21, 2015 @ 09:00 AM

Medicare Part D Plan Changes: What to Look For

Posted by Medicare Made Clear

medicare part dEach year, Medicare Part D prescription drug plans may change what they cover and how much plan members may have to pay, so it makes sense for plan members to review their plans each year, too. You can join or switch Medicare Part D prescription drug plans during Medicare Open Enrollment (Oct. 15 – Dec. 7).

Here’s what to look for before deciding whether to stay with your current Medicare Part D plan or switch to a different plan.

List of Covered Drugs

Most Part D plans have a formulary, or list of covered drugs. Plans may add drugs to the list or remove them from the list each year. Drugs may also be moved from one tier to another by a plan that has a tiered formulary. It could affect how much you pay, if your drug changes tiers.

  • Check to make sure the drugs you take are on your current plan’s formulary
  • Review the formularies of all Part D plans you’re thinking of joining
  • Evaluate the cost of your drugs with each plan you consider

Premium Amount

Plans that have higher premiums may have lower deductibles, copays and other costs, and vice versa. Your current plan premium may be higher or lower next year compared to this year.

  • Check your Part D plan materials to see what your premium will be for 2016
  • Compare premium amounts across the plans available where you live
  • Consider all your out-of-pocket Medicare costs, not just the premium

Deductible, Copays and Other Costs

The deductible and copays could be relatively high for plans with a low premium. But Medicare Part D plans may not charge a deductible of more than $360 in 2016 ($320 in 2015). Deductibles and other costs vary from plan to plan, so it could pay to shop and compare.

  • Check your Part D plan materials to see what your deductible and other costs will be for 2016
  • Consider when, or if, you will meet the plan deductible; a low deductible may be less important if your drug costs are very low
  • Try to estimate your total costs with each plan option; the Medicare Plan Finder may help

Donut Hole Coverage

You will enter the coverage gap, or donut hole, in 2016 after you and your plan have spent $3,310 on covered drugs. Not everyone reaches the coverage gap. But if you do, you will likely pay more for your drugs while you’re in it.

  • Estimate your drug costs using the Medicare Plan Finder
  • Consider when, or if, you will reach the coverage gap
  • Look for plans that offer additional coverage during the coverage gap, if you need it

Preferred or Mail-Order Pharmacy Benefit

Plans may charge different copay amounts depending on where you fill your prescriptions. Plans may have network pharmacies, preferred pharmacies or mail-order pharmacies.

  • Look into the pharmacy benefits of plans you’re considering
  • Consider what pharmacies you like to use and those you might be willing to use
  • Check whether you can save with a 90-day prescription or a mail-order pharmacy


Medicare Open Enrollment (Oct. 15 – Dec. 7) exists so that you have a chance to change your Medicare prescription drug plan or Medicare Advantage plan once each year if you decide to. You could benefit from shopping around and comparing plans.

Related Content

Get Help Managing Out-of-Pocket Medicare Costs

Original Medicare + Supplement or Medicare Advantage: Can You Switch?

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.


Y0066_150929_130556 Accepted