Welcome to Week 3 of Medicare Open Enrollment for 2023! I hope you all are having a happy and spooky Halloween! This week, we would like to highlight some additional resources provided by CMS that offer insight into how to find and compare the best prescription drug plans and coverage for beneficiaries.
When thinking about a prospective prescription drug plan, the 4 main components to focus on are: Cost, Coverage, Convenience, and Quality.
Cost can vary greatly from plan to plan and whether or not a beneficiary qualifies to get Extra Help. The total cost of a Medicare prescription drug plan is, generally, made up of: monthly premiums, yearly deductibles, copayment/coinsurance, the existence of a coverage gap or "donut hole", catastrophic coverage, and late enrollment penalties.
Coverage can also vary from plan to plan, differing on what drugs they cover and whether or not there are specific rules in place that must be followed before a particular drug is covered. Referring to a plan's formulary, the list of drugs a plan covers, and the coverage rules detail the what and how of prescription drug coverage.
Convenience is an important consideration when accounting for a prospective beneficiary's geographical location and the plans' networks relative to it. Some plans even offer services such as mail-order programs that may be amenable to beneficiaries' locations and needs.
Quality ratings of Medicare prescription drug plans are available for review by all prospective beneficiaries and are a wonderful indicator and point of comparison across differing plans. Utilizing member satisfaction surveys, plans, and health care providers to generate a rating between 1-5 stars, the number of stars can indicate a plan's overall and categorical quality.
For more information, refer to the CMS's document: "Things to think about when you compare Medicare drug coverage"