Frequently Asked Questions
Plan Finder doesn’t include every drug that Medicare covers. The Plan Finder drug list is updated on a regular basis. If you can’t find your drug, contact your plan to find out if it is covered. Remember that Medicare drug plans may choose to cover some or all of the drugs that Medicare covers. Plans may also cover drugs that aren’t listed.
Plan Finder doesn’t show pricing for over-the-counter drugs or diabetic supplies (e.g. test strips, lancets, needles), so these items can’t be added to your drug list.
A number of factors affect drug prices: drug dosage and quantity selected, pharmacy selection, the subsidy level of the beneficiary, as well as the actual timing for drug purchases. Plan Finder provides estimated pricing for what you will pay at your pharmacy. If the dosages and frequencies you use on Plan Finder are different than what you’ve been prescribed, you may go into a coverage phase that may have an effect on the cost share you pay.
Generally, plans are able to negotiate more competitive pricing from mail order pharmacies, but this may not always be the case. In order to find the most cost-effective way to buy your drugs, refer to the Drug Benefit Summary popup you’ll find on the Plan Comparison and Details pages, or you can contact the plan.
Plans can have preferred dosages that are provided to beneficiaries at a discounted price. For example, a preferred generic version of a drug may cost the beneficiary less than the brand name drug.
Plan Finder drug prices are updated regularly from October through August. Pricing for the current year is frozen in September in preparation for the new plan year’s display.
Why is a new drug that I am taking, or my doctor recommended, not listed in the Medicare Plan Finder? Does this mean that it is not covered by any prescription drug plans?
In order for a new drug to be listed in the Medicare Plan Finder it must first be added to the CMS Formulary Reference File (FRF). The last FRF was created in July so drugs that have come onto the market since then will not be listed in the Medicare Plan Finder until early 2018. However, prescription drug plans may still be covering your new drug. You can call the plans directly, or check their websites for more up-to-date information.
A certain radius is selected to display pharmacies in your area. In order to find more or other pharmacies, you can increase the search radius or use the “Search by Pharmacy Name or Address” feature.
A network pharmacy is a pharmacy that a plan contracts with to offer drugs at a certain price. Some plans distinguish network pharmacies as preferred over other pharmacies, because they can offer better drug prices or better benefits.
In order to provide the most accurate estimated total cost of drugs, Plan Finder needs drug dosage and quantity information as well as the plan information and pharmacy so that the appropriate pharmacy costs can be included.
If the ‘Confirmation’ page displays with a 14-digit confirmation number, your enrollment has been saved. You should write down the confirmation number or print the confirmation page so that you can refer to it later, or when you want to call the plan or 1-800-MEDICARE.
You can always perform a General Search using only your zip code. You will then be asked to enter other information for a more accurate search, such as the list of your drugs and your favorite pharmacies.
For a more Personalized Search, at minimum you will need to have:
- Zip Code
- Medicare Number
- Last Name
- Effective Date for your plan
- Date of Birth
In Step 1 of 4 of the search, an option appears under this question: “Do you get help from Medicare or your state to pay your Medicare prescription drug costs?” This allows you to indicate that they are receiving help from Medicaid.
In Step 4 of 4 (Refine Your Plan Results) of the search, expand the “Select Special Needs Plans” option on the left side of the screen. Check “plans for people who are eligible for both Medicare and Medicaid” and update the Refine Your Plan Results page. As you proceed to the Plan Results page, you will see some plans titled “Medicare-Medicaid Plan” as well as other plans you may want to look at, including special needs plans.
In Step 2 of 4 (Enter Your Drugs) of the search, select the button “I don’t want to add drugs now” and when the pop-up appears, select “Skip Drug Entry.”
After selecting drugs, Step 3 of 4 (Select Your Pharmacies) show the list of pharmacies within 1 mile of your zip code. You may choose to widen the search parameter by selecting up to 6 mile radius from your zip code.
If the pharmacy is not in your zip code, you may type a new address by selecting “Search New Location or by Pharmacy Name”.
In Step 4 of 4 (Refine Your Plan Results) of the search, expand the “Select Special Needs Plans” option on the left side of the screen. The various special needs plan options will be listed on the next page of the search, the Plan Results page.
When viewing the search results, some plans will show a blue information button indicating that comparison is suppressed. Some of these plans may be categorized as Medicare-Medicaid Plans. These plans can’t be compared with other Prescription Drug Plans.
There may be several reasons why Plan Finder doesn’t offer an enrollment option for some plans. For example, some plans opt not to offer an online enrollment option. And, some low performing plans are restricted from offering online enrollment.
Sometimes when I do a plan search with drugs, I can’t use the enrollment button; Plan Finder tells me to contact the plan to enroll. However, when I do a search without adding drugs or look the plan up directly, I can use the enrollment button. What does this mean?
If you can’t use the enrollment button, it may be because the plan is “Part D Suppressed”. With Part D Suppression, there has been an inaccuracy in a plan’s drug pricing submission. The enrollment button will be disabled ONLY if you do a search with drugs. If you do a search without drugs, the enrollment button can be used. Plan Finder discourages enrollment into plans that have submitted inaccurate drug prices.
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