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Which policies include your prescriptions on their formulary (list of covered drugs)?

This is the third in this series. To start at the beginning, go to 5 Questions to Ask Before Enrolling.

You might as well drill a big hole in the bottom of your bank account if you overlook this question. If you take any expensive drugs or think you might in the near future getting the right drug coverage will keep more of your money in your pocket.

You could unnecessarily pay $200 or $400 or more per month because you don’t have prescription drug coverage. You could pay just as much if you do have drug coverage, but have the wrong coverage.

If you decide to purchase a Medicare Supplement Plan, you will probably need a separate Prescription Drug Plan unless you choose to go without coverage for drugs. No currently sold Medicare Supplement Plan provides prescription or dental coverage.

Conversely most Medicare Advantage Plans do cover prescriptions. Some include dental coverage as well.

No policy covers every drug, so it pays to check the formulary (list of covered drugs) for any plan you want to enroll in.

You can easily determine which policies cover your drugs by visiting

Starting from the home page:

  1. Click the ‘Find health & drug plans” button
  2. Enter your zip code on the next page
  3. Click the “Find Plans” button
  4. Answer the questions on the next page
  5. Click the “Continue to Plan Results” button
  6. Enter your prescription information
  7. Click the “My Drug List is Complete” button
  8. Select your pharmacies
  9. Click the “Continue to Plan Results” button

If you haven’t ruled out Medicare Supplement Plans

On the next page, select “Prescription Drug Plans (with Original Medicare)” if you are considering enrolling in a Medicare Supplement. You will need to get this important coverage from a standalone Prescription Drug Plan, if you don’t get “creditable coverage” from the Veterans Administration or elsewhere. (Creditable coverage meets the Medicare standards and helps you avoid the penalty for not having drug coverage.) Neither Original Medicare (Medicare Parts A and B) nor any currently sold Medicare Supplement Plans cover prescription drugs.

If you haven’t ruled out Medicare Advantage Plans

If you are not considering a Medicare Supplement Plan or haven’t decided which category will be best for you, select “Medicare Health Plans with drug coverage.” (You can select both if undecided).

For the purposes of this post “Medicare Advantage Plans” and “Medicare Health Plans” mean the same thing.

Only select “Medicare Health Plans without drug coverage” if you have decided against getting prescription drug coverage.

After you click the “Continue to Plan Results” button you will see all plans available in your area that meet your criteria. They will be listed in an order designed to make selecting a plan easier.

Look at the fourth column of the table to see if all your drugs are on the formulary for any given plan and to see if there are any drug restrictions. You can click on the word “No” for more information if you see “All Your Drugs on Formulary: No.” You can click “Yes” for more information if you see “Drug Restrictions: No.”

If Your Drug Costs Will be Over $50 a Month

It might pay for you to see which pharmacy will have the lowest cost for your prescriptions. Click on the name of a plan and then click on the “Drug Cost & Coverage” tab to see how much each pharmacy will charge you. Then circle back to the “Select Your Pharmacies” step, but clicking on the link near the top of the page. Then select two different drug store and repeat the steps to see which one will cost you the least.

Bottom Line

If you are used to paying copays for your drugs, you may be in for a rude and expensive awakening if you enroll in a plan that does not cover your particular list of drugs or doesn’t cover them well. Make sure you know what your drug costs are likely to be before you make a final decision.

Be sure to print this list before going to the next question. Mark the plans that have all your prescriptions in their formulary.

Want Recommendations the Quick and Easy Way?

Complete this questionnaire and you will get a recommendation by email for the plan I think you will find covers you best.

To start at the beginning of this series click here.

About Post Author

Alston J. Balkcom

“ Connecticut-licensed insurance agent since 1985.”

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