What's the biggest mistake seniors make when choosing a Medicare Part D plan?

Question

Timothy Brown · Accepted Answer

The 2 biggest mistakes that seniors make when choosing a Medicare Part D plan are:

1. Not verifying the listed prescription or tier level on the plan's formulary.

2. Enrolling in a plan where the monthly premium is excessive in comparison to the monthly cost of the prescriptions. Example: Paying a $103/month for plan for when you're only taking generic prescriptions.

Larry Dalton · Answer

With the changes made in 2025 to the drug formulas and tears, it is wise to analyze all the plans. Cheaper premiums could cost you more in the long run at the pharmacy. I would always investigate the drug plans each year.

Answered by Larry Dalton on April 17, 2025

Broker Licensed in OK & TX

Answered by Larry Dalton Medicare Insurance Agent

William Gray · Answer

The Biggest mistake that people make with part D is not reviewing it annually.

Cost per company and Formulary teirs change every year. 

You may be paying for more than you need to without an annual review.

Steven Whetstine · Answer

One of the biggest mistakes is choosing a plan based solely on the premium and not factoring the out of pocket costs and pharmacy or pharmacies that will be used.  

A Medicare beneficiary will want to check to see if their preferred pharmacy is in the network for the Part D Prescription Drug Plan.  Each insurance carrier will have different preferred pharmacies within their network.

It is important that one identifies the correct prescription that will be taken when reviewing the formulary under the plan.  It can make a difference if reviewing tablets versus capsules or brand name versus the generic option.

It is important to review the Part D plan annually as your needs may change with prescriptions, and the plans change annually.  Premiums, deductibles and copays can shift each year.  Also, prescription formularies can change tiers from year to year.

Also, it is a great idea to have a discussion with the medical professionals who prescribe prescriptions to identify which medications would work well to treat you and what options could potentially save you money.

It is always good to look at the bottom line.  You always want to look at the total estimated costs rather than which plans offer you the lowest premium.

Joseph Meyers · Answer

Other than not talking to me first....a few possible mistakes could be made:

1. Not using medicare.gov to compare all plans against your medications. 

2. Not checking your drug coverage every year, by comparing new plans or if you were prescribed new meds

David Didier · Answer

Hello ,

On the Part D, (Prescription drug coverage).

 I get a list of your prescriptions you are currently taking, then I go to the Medicare.gov

I check what plans cover the drugs and the pharmacies at the lowest cost, so you can get the best prices and control the budget for your cost for the year!

It is best to check all your cost at the pharmacy you use, (it might be costing you a lot, or it might be the best, the Medicare.gov site lets you know, call me, I can help!

Thx!

R Scott Bradley · Answer

Taking an unsolicited call from a telemarketer and providing personal information. Stupid is Is stupid does.

Steven Bleicher · Answer

Not knowing that a Part D drug formulary can be changed to eliminate your drug anytime during the year. Naturally, this is outrageous! It will happen with brand name drugs due to the volatility of all Rx's nowadays. I feel that this is THE biggest challenge facing seniors today.

Answered by Steven Bleicher on May 29, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Michael Pyers · Answer

They need to make sure that the Medicine is on the formulary of a plan before enrolling.
They also need to check for overall cost per Medicare.gov. They need to make sure that the pharmacy they use is covered and other options for Pharmacies are in the preferred network for the lowest cost for Meds.

Diana Salisbury · Answer

One mistake might be that they think that all copays are the same. Most plans require that a deductible be reached on Tier 3 and higher tiers before the cost of their expensive prescription is reduced.

Answered by Diana Salisbury on May 11, 2025

Broker Licensed in OH, IN & MI

Answered by Diana Salisbury Medicare Insurance Agent

Rick Boyd · Answer

By not checking if your medications are on the plans formulary. Or deciding that you do not need a part D plan because you don’t currently take medications.

Satoshi Aoki · Answer

It is important to choose a Part D plan even if you are healthy when you turn 65. If you delay your application, you will incur a penalty and have to pay additional premiums. Furthermore, the penalty will continue.

reference

https://www.medicare.gov/health-drug-plans/part-d/basics/costs

Peter Joseph · Answer

You need to make sure all your formulary prescriptions are covered under that part D plan. There is away for us to check that. Certain prescriptions do fall under Part B.

Steve Brauer · Answer

Usually the biggest mistake people make when choosing a Part D Drug plan is they go for the cheapest alternative. Many Part D plans are very inexpensive, but if you look closely, the Prescription Drug list, or formulary, that they cover may be lacking or thin in some areas.

Answered by Steve Brauer on April 14, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Mike Henry · Answer

Price versus total cost benefit. Just because a company may have the cheaper premium doesn’t mean it’s the best. A higher price Psrt D may cover overall drug costs better

Linda Davies · Answer

An agent can help seniors better understand a Part D plan formulary and how it aligns with their specific medication needs. It is also important not to overlook coverage restrictions like prior authorization or tiered drug costs, which can lead to unexpected expenses or inability to access necessary medications.

Answered by Linda Davies on May 30, 2025

Broker Licensed in IL

Answered by Linda Davies Medicare Insurance Agent

David Christian · Answer

Getting a plan that doesn't have the prescriptions on the formulary. If you have a broker, this should never happen without you knowing the prescription wasn't covered beforehand and you are going into it asking for an exception from the carrier.

Answered by David Christian on April 8, 2025

Broker Licensed in CA & TX

Answered by David Christian Medicare Insurance Agent

Todd Bostic · Answer

They don't make sure all of their medications are covered, they say they only take 1 or 2 medications, and then the agent signs them up for an inexpensive plan that doesn't cover all of their medicines. The Agent needs to verify all of the seniors medicines are covered at the least expensive cost for them, and then when you add the meds, the agent should still be able to tell you the most cost effective plan available to you over the course of a year, not just a month.

Answered by Todd Bostic on June 2, 2025

Broker Licensed in TX, AL, AZ & 12 other states

Answered by Todd Bostic Medicare Insurance Agent

Mel Stevens · Answer

By and far the biggest mistake is not electing Part D in a timely manner! Once you receive your part B effective date, Medicare will give you a 60-day window to elect a prescription medication plan. If you exceed the 60-day window, Medicare can and will penalize you for the rest of your life. It's very important to know these rules which unfortunately aren't explained or conveyed very well. Even if you don't take any medications, you still need to sign up for a Part D prescription medication plan. There are various Part D plans available in each state. If you don't take any meds or just perhaps a couple generics, tier 1 and tier 2 medications, there are some zero premium Part D plan available in Arizona. Premiums and formularies vary from company to company and plan to plan. It's important to check the formularies to ensure your meds are covered and to calculate your expected medication costs.

Answered by Mel Stevens on April 15, 2025

Broker Licensed in AZ

Answered by Mel Stevens Medicare Insurance Agent

Robert Remin · Answer

This answer is provided in a video format. Watch the agent's video response here: https://medicareagentshub.com/questions/whats-the-biggest-mistake-seniors-make-when-choosing-a-medicare-part-d-plan#robert-remin

Kerwyn Jones · Answer

Not checking the formulary to ensure all their prescriptions are covered. Also, simply forgetting to enroll within the time frame allowed for it

Rene Apack · Answer

The biggest mistake seniors make when choosing a Medicare Part D plan is that they go by company names that they know instead of analyzing the whole marketplace, AND finding a PLAN THAT WILL ASK FOR THE LEAST AMOUNT OUT OF THEIR POCKET.

Answered by Rene Apack on June 23, 2025

Broker Licensed in IL, AL, AR & 25 other states

Answered by Rene Apack Medicare Insurance Agent

Joseph Lombardo · Answer

In my opinion, the biggest mistake seniors make when it comes to choosing a part D plan is focusing too much on plan premium. In addition to the premium, the senior should focus on deductibles, copays and the tier of prescription drug they're taking. When you focus on these items, you can get a much clearer picture of your yearly cost for your medications. I hope this helps.

Answered by Joseph Lombardo on May 5, 2025

Agent Licensed in NY, CT, NJ & PA

Answered by Joseph Lombardo Medicare Insurance Agent

Dan Calabrese · Answer

Looking at the cost of the monthly premium and the plan deductible without looking at the total cost when factoring in copays for medications. Also, assuming that they need to obtain the part D plan from the same carrier as their Medicare supplement.

Answered by Dan Calabrese on April 14, 2025

Agent Licensed in NY, CT & MA

Answered by Dan Calabrese Medicare Insurance Agent

What's the biggest mistake seniors make when choosing a Medicare Part D plan?

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What's the biggest mistake seniors make when choosing a Medicare Part D plan?

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