By Boettcher Insurance
Recent changes to Medicare Part D prescription drug coverage are shaking things up, and many people are facing tough choices when it comes to their plans. We know times are tight, and it can be tempting to go for the lowest cost option. However, simply choosing the cheaper plan can end up costing you more in the long run if you’re not careful.
As insurance brokers, our job is to help you navigate these changes, not just to save you money today but also to protect you from financial stress down the road. Unfortunately, we’re seeing more and more people pick lower-cost plans without fully understanding the consequences. While saving a few dollars a month on premiums might feel good now, it could lead to significant out-of-pocket costs if you find yourself needing a high-cost medication later.
Why Thorough Coverage and Checking Formularies Matters
With Medicare Part D’s updates, including the $2,000 cap on out-of-pocket costs starting in 2025, you might think you’re fully protected. But it’s important to remember that the cap doesn’t mean your plan will cover everything you need. One critical thing to check before switching plans is the drug formulary. This is the list of medications your plan covers. Cheaper plans often have more limited formularies, which means they may not cover certain medications or may require high co-pays for more expensive drugs.
For example, some low-cost plans focus heavily on generics, which is great if you don’t take anything beyond basic medications. But what if your health changes and you need a specialty medication for a new condition? Without the right coverage, you could be stuck paying thousands of dollars out of pocket even with the Medicare cap.
Planning for the Future, Not Just the Present
When choosing a Part D plan, thinking about more than just your current health needs is important. Ask yourself: “What if I need more expensive medications in the future?” A plan that seems like a good deal today might not give you the flexibility you need later. Remember, once you enroll in a plan, you’re locked into it until the next enrollment period. So you’ll want to make sure your plan’s formulary covers all potential medications you may need.
We’ve seen too many people choose a plan that saved them $10 or $15 a month, only to be hit with high costs down the road when their needs changed. That’s why we recommend reviewing all of your options carefully. By choosing a plan with a broader formulary and better coverage, you can avoid the risk of costly surprises.
The Real Cost of Going with a Cheaper Plan
It’s easy to focus on premiums, but you also need to think about the big picture. In our experience, people who choose plans based purely on price often end up paying more in co-pays, deductibles, and prescription costs. This is especially true if your health situation changes unexpectedly.
For instance, a study by the Kaiser Family Foundation found that while monthly premiums for Medicare Part D plans have stayed fairly stable, out-of-pocket costs for certain prescription drugs have risen sharply.
Protecting Yourself for the Future
We know it’s tough to make these decisions, especially when money is tight. But choosing a plan that protects you both now and in the future is essential. Our goal as brokers is to make sure you’re fully covered. Not just for the present, but for those “what if” moments down the road. If you’re unsure about your current plan or thinking about switching to a lower-cost option, we’re here to walk you through your choices and help you find the best plan for your health and your wallet.
Sources: Kaiser Family Foundation; Medicare.gov; AARP
