How To Use Medicare.gov To Estimate Prescription Prices

Welcome to the NJ Life and Health Video on how to use Medicare.gov to understand your drug plan.  This is a resource we are providing to help you through the process of viewing the costs in your current plan, as well as determining what drug plan might be best for you if your current drug plan is no longer meeting your needs. 

 

Getting To Medicare.gov  

  1. Open your web browser and enter in the search bar www.medicare.gov

  2. Look for the button that says find plans on the bottom right and click. 

  3. The page you are on should now say “Find a Medicare Plan” along the top, and give you the option to log in or create an account, or continue without logging in. You are free to create an account, log in, or hit the “continue without logging in” button.  

 

Getting To The Drug Plan Comparison Tool 

  1. Once you hit the continue without logging in button or logged into your account, it is going to take you to a page with a few options asking, “What type of coverage are you looking for?” Click the circle next to the words Drug plan.

  2. This will then open a box prompting you to enter your zip code. Enter in your zip code, and hit the green continue button. 

  3. Upon doing that, you are going to be prompted with one more set of questions below. If you do not receive extra help with prescriptions costs through a government program, please select the “I do not get help from any of these programs” button. Then hit the green next button. 

  4. Now they will ask “do you want to see your drug costs”. Please select yes, and then hit the green next button. 

 

Adding In Your Drugs 

  1. You should now see a search bar with the title “Add prescription drugs”. Here you can enter the drugs you are taking. Please stop here and if you don’t already, make sure you have your prescriptions in front of you. You need to enter these drugs exactly as they are listed on your prescriptions. Any mistakes like missing an Extended release or a hydrochlorothiazide combination can make a huge difference in estimated drug costs.

  2. Start typing into the search bar one drug at a time. As you begin to type in the medication, a drop down appears with all the medications that come close to what you are typing in. Once you see your medication, please click that drug on the list. Then hit the green add drug button. 

  3. Before it will add on to our drug list, you are going to need to answer the specifics about the medication like the dosage, quantity, and frequency of the medication. Check your bottle for the dosage to make sure it is correct, and we advise top leave the frequency and quantity monthly to get the most accurate numbers. Once you’ve got the Quantity, frequency, and dosage correct, go down to the green add to my drug list button and click, and that’s going to add it to our drug list officially. 

  4. If you’re taking more than one mediation, click the white add another drug button, where you’ll be taken back to the search bar to add more medications. From here just repeat the previous process.  

  5. Remember, be as specific as possible! If for some reason what you are typing into the search bar does not come up, it may be that you are spelling it incorrectly, only the generic exists, or that is not covered by Medicare drug plans. Remember things like vitamins are typically not drugs, and therefore not listed under the plans.  

  6. Once you’ve added your drugs, hit done adding drugs. This will take you to a page to choose pharmacies. 

 

Choosing Your Pharmacy 

  1. Find your pharmacy and click the check box next to it.  

  2. Note: You may not want to just add the pharmacy that you use. Different drug plans use different pharmacies as preferred locations, which results in better costs depending on the plan that you are in or are looking at. Not only do you want to click the mail order pharmacy button, but you’ll want to choose a few other pharmacies local to you to see the best costs.  

  3. Once these are selected click the Done button in the bottom right-hand corner. 

 

Viewing Your Plans 

  1. Now we you be presented with a page that shows the different drug plans available in your area. Basically, you’ve made it! 

  2. Before going any further, make sure that this information is sorted correctly. Head up to the box on the upper right-hand side that says, “sort plans by”, and make sure that the drug plans are being organized by lowest drug + premium cots. This will put the plans in annual cost order including premium and drug cost, from lowest cost to highest. This price estimate will be listed under “Retail Cost: Estimated total drug plus premium cost” 

  3. Our recommendation is to keep an eye on the first page of recommendations that you see, given that typically anything past this point is going to be an overpayment or have relatively higher prices. 

  4. If you already have a Medicare drug plan, try to find it here on the list. This way you know how it compares to the plans around it for the year coming up, and how it will do if you stick with it. 

 

Checking The Cost On Your Current Plan 

  1. Once you find your plan (or one you are interested in), click into the “plan details” button to get the cost breakdown. Once you click that button, it’s going to open more specifics on the plan. 

  2. Towards the top of the page, you will see the premium and the deductible for the plan. 

  3. As you continue to scroll down you will see list of covered pharmacies. This will determine for you if the pharmacy is standard or preferred. You will want to steer towards the preferred pharmacies, because this is where you’ll get the best prices. Standard pharmacies will fill your drugs, but they have the right to do so at a much higher rate. In addition, medicare.gov is only going to give an estimate of what the national average is for drugs at these standard pharmacies. 

  4. If the pharmacy you use is preferred, this is the plan for you. If your pharmacy is not preferred and you are not comfortable using these other pharmacies, you may need to choose another plan. 

  5. As you scroll to the next section, you are going to see a yearly cost by pharmacy, for each drug. This is where you will really see the difference between the cost at preferred or standard pharmacies. 

  6. Below that you’ll see the estimated yearly cost at each pharmacy, and when you’ll meet your deductible. If it says you won’t meet your deductible, that means that your drugs either don’t apply towards the deductible, or the cost isn’t enough to hit that deductible amount. In addition, you’ll see when you will enter the coverage gap or donut hole.  

  7. Next, you’ll see your drug costs by month. This will show you very clearly the change between the upfront deductible, the initial coverage, and the donut hole.  

  8. Finally, you’ll see “estimated drug cost during coverage phases” where you see the pharmacies listed out. Click your pharmacy. 

  9. This will provide a drop down of all your drug cost monthly, and what that cost is in each coverage phase. Here you can see the retail cost, which is to the company, and then the price relative to each coverage phase. If the deductible applies to your drugs, you’ll see the cost change from the before and after deductible column. If the deductible doesn’t apply to the drug, you’ll see the cost stay the same.  

  10. The column showing the cost in the coverage gap will give you your payment amount for the drug if you enter the donut hole. The donut hole comes on when you and company spend $4430 combined on medications. To see what the company is spending, look at the retail cost column. If you spend $7,050 you will leave the donut hole, and head into the cost after the coverage gap. 

 

Viewing Your Plans Summary of Benefits 

  1. If you scroll towards the bottom, you will see a blue button that says, “view more drug coverage”. Click that, and it will open a generic summary of benefits for the plan.  

  2. On the left-hand side, you will see the tiers listed out, and the corresponding price that goes with it. This is shown in all the coverage phases. 

  3. There is also a drop-down box in the top left corner to change the tier costs from preferred pharmacy to standard, and mail order. 

  4. Further down, you will see what the tiers of your drugs are. You will also see if the drug needs prior authorization, which will require the doctor to call into the company to confirm the medication, or quantity limits, which will put a limit on the number of pills or amount of drug that can be filled. The step therapy indicates that other drugs will need to be considered before this one is covered. Below that we can see the quantities we enter to confirm they are correct. 

  5. The last bit of information at the bottom is about chemotherapy and part B medications. A lot of people fret here thinking they will not have coverage for these treatments, but it is their drug plan that does not cover part B or chemotherapy drugs because part B of Medicare does instead. 

  6. Now that we’ve seen it all we can go back to the top of the page and click back to search results. 

 

Comparing Different Plans 

  1. The simplest way to compare plans is to look at the estimated yearly retail cost for each plan, and choose one with a lower, more fair cost. Otherwise, you can use the plan comparison tool.  

  2. On each drug outline you’ll see an add to compare box in the corner, go ahead and click it. Once you add more than one, you can hit the compare button in the bottom corner to compare the two. Unfortunately, this is only going to show you generic differences. 

  3. To find the real difference, you must hit the plan details button. The main place to look for differences besides the overall cost will be in the pharmacies, the monthly drug costs, and in the tier structure. 

 

Enrolling In A New Plan 

  1. You can click the enroll button here on Medicare.gov, but we do not recommend it. If you enroll on Medicare.gov we cannot assist you with any plan changes or issues, nor answer your questions. We will no longer officially be your broker.  

  2. We recommend if there is a plan you would like to switch to, please contact us and we will assist you in doing such.  

  3. Hopefully this video has helped, and any questions please direct them to our website at www.njlifeandhealth.com, or call us at 848-226-6897.