The start of a new year often means new beginnings, and for many Medicare beneficiaries, that includes a new prescription drug plan. If you changed your Medicare Part D coverage during the Annual Enrollment Period last fall, your new plan is now in effect. While this can bring better savings or coverage, it can also mean adjusting to new costs, pharmacies, and formularies.
At Carolina Senior Benefits, we know that understanding your new plan can feel overwhelming at first. Here’s a simple guide to help you navigate your Medicare Part D coverage so you can make the most of your benefits this year.
Review Your Plan Documents
When your new Part D plan started in January, you should have received a packet of materials from your insurance carrier. These include your Evidence of Coverage (EOC), Summary of Benefits, and a formulary, which lists all the drugs covered by your plan.
Take some time to review these documents carefully. Key details to look for include:
- Monthly premium: The amount automatically deducted or billed each month.
- Annual deductible: How much you pay out of pocket before your plan begins covering costs.
- Drug tiers: Each medication is assigned to a tier that determines your copay or coinsurance.
- Preferred pharmacies: Some pharmacies offer lower copays for plan members.
Tip: Keep all your plan documents in one folder so you can reference them throughout the year. Staying organized makes it much easier to track what’s covered and what your costs should be.
Confirm Your Pharmacy Network
Your choice of pharmacy can make a big difference in your out-of-pocket costs. Each Medicare Part D plan has its own network of pharmacies, and some are designated as “preferred,” meaning they offer the lowest prices.
Start by confirming whether your usual pharmacy is part of your plan’s preferred network. You can do this by:
- Visiting your plan’s website or mobile app
- Calling your plan’s customer service number
- Asking your local pharmacist to check for you
If your regular pharmacy is not in the preferred network, you may want to transfer prescriptions to one that is. You can also explore mail-order options for maintenance medications, which can be convenient and sometimes even more affordable.
Even within the same network, drug costs can vary between pharmacies. Taking a few minutes to compare prices could save you hundreds of dollars over the course of the year.
Check That Your Medications Are Covered
Every Medicare Part D plan has its own formulary, or list of covered drugs, and this list can change from year to year. Just because your medication was covered under your old plan doesn’t guarantee it’s covered under your new one or that it’s in the same cost tier.
Log in to your plan’s online portal or check your printed formulary to verify that your prescriptions are included. Look for:
- The drug name (brand or generic)
- The tier level (typically ranging from 1 to 5)
- Any special requirements, such as prior authorization, quantity limits, or step therapy
If you notice a medication isn’t covered or has moved to a higher tier, talk to your doctor. They may be able to prescribe an alternative drug that’s more affordable under your new plan. Your pharmacist can also help you identify generic or therapeutic equivalents.
It’s best to catch any coverage issues early (before you run out of your medication) so there’s time to resolve them without gaps in treatment.
Set Up Online Access or the Plan’s Mobile App
Most Part D plans offer online member portals or mobile apps that can make managing your prescription coverage much easier. Once you create an account, you can:
- View your drug list and coverage details
- Track claims and see how much you’ve paid out of pocket
- Order refills or set up mail delivery
- Review your Explanation of Benefits (EOB) statements
- Get alerts about formulary changes or drug price updates
Some carriers even provide tools that compare drug prices across local pharmacies or suggest lower-cost alternatives. Setting up online access early in the year helps you stay informed and avoid surprises later on.
If you’re not comfortable using online tools, many plans also offer phone support where representatives can walk you through your benefits step-by-step.
Know Who to Contact for Help
Even with preparation, questions can come up. It’s important to know where to turn when you need help.
- Your plan’s customer service: Contact them for questions about specific drug coverage, billing issues, or claims.
- Your pharmacy: They can help clarify copays, refill timing, or prescription transfer questions.
- Your Carolina Senior Benefits agent: We’re always here to explain your benefits in plain language, help you compare pharmacy options, or assist if your medication suddenly becomes more expensive.
You don’t have to handle your Part D plan on your own. A quick conversation with an experienced agent can help ensure you’re using your plan effectively and avoiding unnecessary costs.
Prepare for Next Year’s Enrollment
It may seem early to think about next year’s Annual Enrollment Period (AEP), but a little recordkeeping throughout the year can make future decisions much easier. Keep a small notebook or digital note where you record:
- Any prescription changes
- Issues with drug coverage or costs
- Your overall satisfaction with the plan
When AEP rolls around again in the fall, you’ll have a clear record of what worked and what didn’t. That makes it much simpler to evaluate whether you want to stay with your current plan or switch to a new one.
Make the Most of Your Medicare Part D Plan
Starting a new Medicare Part D plan can take some adjustment, but a little time spent learning the details now can pay off throughout the year. Review your plan materials, confirm your pharmacy network, double-check your drug coverage, and take advantage of your plan’s online tools.
At Carolina Senior Benefits, we specialize in helping Medicare beneficiaries understand their coverage and make confident, informed choices. If you have questions about your new prescription drug plan or want to make sure you’re getting the best value, we’re just a phone call away.
Here’s to a healthy and well-informed year ahead!
