What's the biggest mistake seniors make when choosing a Medicare Part D plan?
Answered by 21 licensed agents
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.
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.
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!
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.
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.
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.
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.
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.
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.
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.
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
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.
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.
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.
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.
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.
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.