Last updated October 2022
Thank you for the opportunity to help you with your Medicare Part D Prescription Drug plan decision for 2023. OnlyHealthInsurance does not represent, sell, or market Medicare Part D drug plans but has been consulting in this market since the programs launch in 2006. We look forward to presenting our recommendation to you.
Let me share with you how we come to our recommendations. Using the Medicare Plan Finder on the Medicare website, as well as private web resources, we can apply our knowledge to narrow down the selection (there are 26 qualified plans in 2023). Here is a list of the factors we consider before making our recommendation:
1). Are currently used drugs included in the plan
2). Cost factors (deductible, premium, drug copays and cost sharing).
3). Drug Plan Restrictions (Quantity Limits, Prior Authorizations and Step Therapy)
4). Plan Ratings (plan responsiveness, efficiency, quality and other functions are measured by CMS
5). Drug Formulary size
6). Plan reputation & experience in Part D
7). Preferred Pharmacy (Plans are now aligning with pharmacy chains to offer deeper discounts when utilized)
8). Personal Preferences (goals, requests and intentions)
Since all plans are structured based on four standardized benefit levels within an annual cycle, plan rankings from the plan finder are based on how well plans perform through these levels. It is this plan design that makes Medicare Part D a unique program. To understand how the Plan Finder ranks plans, it is important to understand these levels. It will directly affect your share of costs. Our graph and explanation below will shed new light on the program.
*In 2023, Part D plan members will receive a 75% discount on the total cost of their covered brand-name drugs purchased while in the donut hole. Of this 75% discount, 70% of it is paid by the brand-name drug manufacturer and will apply towards one’s out of pocket (known as Total or True Out of Pocket or TrOOP) and getting out of the donut hole. The remaining 5% is paid by the Medicare Part D drug plan and will not count toward one’s out of pocket or TrOOP. Also, Medicare Part D enrollees will receive a 75% discount on generic drugs provided by the Part D plan that are purchased while in the donut hole, and the 25% spent by the member will count towards their TrOOP.
**In the Catastrophic Coverage level of the standard model one will pay $4.15 for generics under $83 and 5% for those above, and $10.35 for brand name drugs under $207 and 5% for those above
Final Note: Our analysis and recommendation is based primarily on information obtained from the Medicare Plan Finder, the resource tool recommended for use by the US government. If it is determined that the information provided by the Plan Finder was incorrect or incomplete you may have no recourse to change plans and we’ll not be able assist you. This comparison has calculated the estimated costs based on drug costs on the day the evaluation was prepared. Drug costs may change during the year.
Important Medicare Phone #s
- For Medicare enrollment: contact Social Security at 1-800-772-1213
- For Medicare coverage questions: call 1-800-MEDICARE
- For government sponsored assistance with Medicare and Social Security contact HICAP (Health Insurance Counseling and Advocacy Program) at 1-800-434-0222
- For information about Medicare Supplemental coverage, contact Phil or John at OnlyHealthInsurance at 1-800-924-1411