Trying to determine which Medicare drug or health plan best
meets your needs can be confusing. These tips can point you in
the right direction.
Go to the official Medicare website, www.medicare.gov.
Press the Find Health & Drug Plans button on the
left side of the next page. (You can also review an online
tutorial on how to use the plan finder on this page.)
On the next page you can perform a General search by only
submitting your zip code. You then press the next few buttons
in regards to having a Medicare supplemental health plan, other
types of coverage or if you receive any financial assistance
towards your plan costs. Be careful. You can also perform a
Personalized search by adding your zip code, your Medicare
number, your last name, your Medicare effective date and your
date of birth.
On the next page, enter your drugs one at a time, including the
correct dosage. If you are not sure of the spelling of a drug
you can use the alphabetic listing provided. This is where you
can also indicate if you can use a generic version of a brand
A list of the drugs you entered will appear. Carefully
review each one to make sure that the dosage listed next to the
medication is the dosage that you are prescribed. If not, press
on the change dose box and select the correct dose (e.g. many
medications can either be 10 or 20 mg per tablet). Check the
frequency (e.g. 30 or 60 pills monthly).
After listing all of your drugs press the My Drug List is
Complete button. At this point you may want to make any
changes to the automated Save Your Drug List feature on
the right side of the page. The system automatically saves your
entered drug list in case you need to make any changes to your
list in the future.
You next will be asked if you want to choose a preferred
pharmacy. You can choose one now or wait to check for a
preferred pharmacy until you review the actual plans. You may
proceed however you prefer. Press the Continue to Plan
On the Refine Your Plan Results page select the type of
plan you are seeking, either a Prescription Drug Plan or a
Medicare Health Plan. Press the Continue to Plan Results
Choose up to three of the plans to compare and review. If you
are searching for Medicare Advantage plans please be
sure to understand their coverage limitations on available
providers, such as physicians or hospitals, and any drug usage
You should sort your results by the lowest estimated annual
drug costs when doing a search during the annual election
period. If doing a search at any other time of year you should
check the drop down box for a feature that allows you to sort
the plans by the lowest estimated cost for only the remaining
months of the calendar year.
When reviewing each plan, be sure to check to see
if the plan has any important utilization restrictions,
such as prior authorization, quantity limits or
step therapy (in which drug therapy for a medical
condition always has to begin with the most cost-effective
therapy, such as using generic drugs, and only includes more
costly medications if deemed medically necessary). This data is
found on the 4th column of the Plan Results
page. It may be worth spending a few more dollars each month on
a premium to avoid some of the restrictions; otherwise you may
need to have your physician assist you with writing a letter to
the plan to overcome any restrictions noted.
If you have any questions, try calling the drug plan
using their toll-free phone number; call Medicare at
1-800-633-4227; or talk to a Virginia Insurance
Counseling and Assistance Program (VICAP) counselor.
VICAP is a counseling program to assist your
understanding of Medicare. There is no cost for this service.
Call the Virginia Department for the Aging toll-free at
1-800-552-3402 to find a local VICAP program.
When you have all of your questions answered and have found the
plan that best fits your current needs, enroll either online
or by phone. It is important to complete your enrollment
during the annual enrollment period (October 15 - December 7).
The new prescription benefit plan will be effective on January
1. Individuals newly qualified for Medicare will be asked to
choose a prescription benefit plan when they first become
eligible for benefits during their Initial Enrollment Period.
Houghton, Virginia Insurance Counseling and Assistance Program:
Fairfax County, VA.
Last Review: November 8, 2012.