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Comparing Medicare Private Drug Plans

Before you start looking at plans:

• Make a list of the medicines you take and how much you currently pay for them. You may want to ask your doctor for help.

• Make note of pharmacies you use regularly.

There are two types of drug plans you can choose from depending on how you get your Medicare benefits. If you have:

• Original Medicare: Choose a stand-alone prescription drug plan (PDP) if you want to continue to receive your other health benefits through Original Medicare.

• A Medicare private health plan (such as an HMO or PPO): Generally, you must get Part D drug coverage as part of your private health plan's benefits package. (If you join a Medicare Medical Savings Accounts (MSA), Private Fee-for-Service (PFFS) plan without drug coverage, or a Cost Plan, you can also join a PDP.)

Get the facts before you enroll in a plan!
Here are some questions to ask.

Covered drugs:

• Does the plan cover all the medications I am taking?

• Does the plan cover the most important medications I take?
  (Ask your doctor.)

• If the plan does not cover a medication I take, does it cover one that will work for me? (Ask your doctor.)

• Does the plan require that I get special permission before it will cover the medication I need (such as prior authorization or step-therapy)?

Cost:

• How much will I pay at the pharmacy (copayments or coinsurance) for each drug I need? (Certain drugs may have high coinsurance.)

• If a drug I take has a very high coinsurance, is there a drug I can take that will cost me less? (Ask your doctor.)

• How much will I pay in monthly premiums and annual deductible?

• Will I have to pay the full cost of my drugs at some point after the deductible (coverage gap)?

Pharmacy network:

• Can I fill my prescriptions at the pharmacies I use regularly?

• Can I fill my prescriptions when I travel?

• What happens if I go to pharmacies that are not in the network?

• Can I get prescriptions by mail order?

Coordinating with your other benefits:

• Will the Medicare drug plan work with my current drug coverage?

Editorial provided by the Medicare Rights Center. Used with permission. www.medicarerights.org.

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