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. It
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. This search will offer more personalized
feedback on the screen.
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
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. Make sure you write down the "Drug
List ID" and the "Password Date" for future
You next will be asked to choose a pharmacy. You need to choose
one now to be able to continue your search. Once you reach the
actual plans you may decide to switch pharmacies if you
identify one that is a preferred pharmacy and might save you
some additional money on the cost of your drugs. Press the
Continue to Plan Results button.
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
button. Remember that a Medicare Health Plan covers all medical
needs, not just drugs.
Choose up to three 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, TTY 711; 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 Aging and Rehabilitative
Services toll-free at 1-800-552-3402, TTY
711 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
Source: Mari de
Leon, Virginia Insurance Counseling and Assistance Program:
Last Review: September 2014