How to review and update your Medicare Part D coverage (Updated Oct. 2024)

Read time: 4 minutes

Open Enrollment runs from October 15-December 7

If you haven’t already confirmed your Medicare Part D (prescription drug coverage) for next year, now's the time to review your plan before Medicare Open Enrollment wraps up December 7. And if you’re not sure where to start, we have some helpful tips for you.

Why review?

A lot can change in a year, and the drug plan that made sense for you this year may not next year.

For example, maybe your doctor has prescribed new medications for you and stopped others. In this case, you want to make sure your plan fits your needs.

Plus, a drug plan can change its co-pay and coinsurance amounts, along with the drugs it covers (or, the “formulary”) each year. So, what was once covered may no longer be. In this case, you want to make sure your coverage fits your budget.

That’s why it’s so important to review your drug coverage to make sure whichever plan you select will meet your medical and financial needs.

Reminder about your Medicare Supplement:

Part D (and Medicare Advantage) plans can change what’s covered annually, so they should be reviewed every year. However, with a Medicare Supplement policy, your coverage is guaranteed renewable, so what’s covered can’t be changed. So, if you have a Medicare Supplement and you’re satisfied, you don’t need to do anything about that coverage during the Annual Enrollment Period.

Before you get started, be sure to review your annual notice of change from your current Part D provider. This will come in useful when you’re comparing your existing plan vs. coverage options for next year.

Comparing Part D drug plans …

… involves a lot of moving parts. These are just a few of the questions to ask:

Coverage

Are my prescriptions covered by the plan’s formulary?
Does the plan’s formulary have tiers? Example:
- Tier 1, most generic drugs
- Tier 2, some common brand drugs and some high-cost generic drugs
- Tier 3, nonpreferred brand drugs
- Tier 4, highest-cost drugs where the plan usually pays only a percentage of the cost (rather than a flat rate)
Are there coverage restrictions such as prior authorization or step therapy (trying a less expensive medication first before “stepping up” to a more expensive one)?

Costs

How much will I pay for monthly premiums and the annual deductible?
How much will I pay at the pharmacy (co-payments or coinsurance) for each prescription?

Pharmacy network

Is the pharmacy I use now in the preferred network?
Can I get prescriptions by mail-order?

Expert help is available — at no charge to you!

The easiest way to get this checked off your list? Ask an expert for help. A licensed insurance professional who’s well-versed in all things Medicare can help you in no time at all. A Physicians Mutual family customer said it best:

“Dear Physicians Mutual family,

Thank you for making the Medicare Part D coverage review such an easy, no-stress process! I provided a list of our medications to our agent. She took it from there. Ten minutes later, we had saved $6,000* for 2020! Wow! We were so pleased … we thought we were locked into the first Part D plan we selected. We weren’t.”

Chuck and Ardie W.

Members of our family since 2015

* Savings will vary, as will the time required to complete the review.

The Physicians Mutual family does not sell Part D. We provide this free service to help Medicare beneficiaries save money.

Other valuable resources

Medicare:

If you prefer to compare drug plans yourself, visit Medicare.gov/plan-compare.

After answering a few simple questions, add your current prescriptions to get cost and pharmacy information, and to see which plans are available in your area. You can create an account or explore as a guest.
State Health Insurance Assistance (SHIP):

If you prefer to have help from a trained counselor, visit shiphelp.org.

While local programs go by different names, the State Health Insurance Assistance Program (SHIP) is a community-based network of counselors throughout the country. SHIP counselors have been screened, trained and certified as Medicare experts.

There’s still time to review your Part D plan!

Whether you’re a DIY-type who’d like to use the compare tool on medicare.gov, or would prefer someone walk you through your options, be sure to get this important review done.

If you change drug plans, you need to be enrolled in your new plan by December 7.

What’s in the stars?

One of the items to consider as you compare drug plans is their quality — or star — rating.

Medicare assigns stars to Medicare Part D plans based on their performance. Stars are based on member satisfaction surveys, plans, and health care providers. A plan can receive a rating between 1 and 5 stars. A 5-star rating is excellent.

You’ll see these ratings when comparing drug plans through the Medicare portal.

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