Medicare Part D in Michigan: How Prescription Drug Plans Really Work

Ask anyone on Medicare what confuses them most, and prescription drug coverage is near the top of the list. Part D plans are offered by private insurance companies, and two plans with similar premiums can produce wildly different costs for the exact same list of medications. Here is how to look past the premium and find what a plan will really cost you.

The four pieces that decide your real cost

• Premium: the monthly amount you pay just to have the plan. Some Michigan counties have low-premium options.
• Formulary: the plan's list of covered drugs. If your medication is not on the list, you may pay full price or need an exception.
• Tiers: covered drugs are grouped into tiers. Generic tiers cost the least; brand and specialty tiers cost the most.
• Pharmacy network: many plans have preferred pharmacies where your copays are lower. The store across the street may not be the cheapest place to fill your prescriptions.

The phases of Part D coverage

Part D costs move through phases each calendar year. You start in the deductible phase on plans that have one, then move to the initial coverage phase where you pay copays or coinsurance. Recent federal changes have simplified the back end of Part D, including an annual cap on out-of-pocket drug costs, so nobody faces unlimited medication expenses in a year.

Because the rules and dollar amounts can change year to year, the smart move is to re-check your medications against the available plans every fall, not to assume last year's plan is still your best deal.

Common Part D mistakes we see

• Choosing a plan by premium alone instead of total yearly drug cost.
• Forgetting that drug lists and pharmacy networks change every January.
• Skipping a review because 'my medications did not change' even though the plan did.
• Missing enrollment and owing the permanent late-enrollment penalty.
• Not checking whether a medication needs prior authorization or has quantity limits.

How we help with Part D

Bring us your medication list and preferred pharmacy, and we will run a comparison of the Part D plans available in your county to estimate your total annual cost, premium plus copays. We do this as part of a free annual review for our clients, and there is no charge for our help.

If your income and resources are limited, we can also check whether you qualify for the federal Extra Help program, which can dramatically lower drug costs, or for a Medicare Savings Program through the state. Call (269) 979-8600 to get started.