Ask the Pharmacist: Medicare Part D Enrollment

Oct 14, 2013
Navigating Medicare Part D enrollment can be confusing. Express Scripts Pharmacist Paul Reyes shares tips for seniors to make an informed decision.
  • Medicare
  • Seniors
  • Caregivers

As an Express Scripts pharmacist, I'm frequently asked for advice on selecting healthcare coverage from family, friends, patients and acquaintances. With Medicare Part D open enrollment beginning Oct. 15, those requests seem to be increasing.

And it's no wonder: recent research from Express Scripts shows many seniors are confused and misinformed about how healthcare reform will impact their Medicare benefit. Our research also uncovered that 60% of seniors still think that choosing the right Medicare plan is confusing, even though the Part D benefit has been available since 2006. With some states offering upward of 36 different plans, Medicare beneficiaries are faced with a number of choices and the process of selecting the best plan can be overwhelming.

Simplifying the Process

If you are over age 65 and do not have prescription drug coverage through an employer or other provider, you should enroll in a Medicare prescription drug benefit. If you miss the Medicare Part D enrollment deadline, you won’t be able to enroll again until fall 2014, unless you qualify for a special election period. It’s possible that a senior could go an entire year without any prescription drug coverage and will pay a monthly penalty for late enrollment.

Here are three tips to help you make the right Medicare Part D decisions:

1. Know Your Dates

You could begin researching Medicare Part D plans as of Oct. 1.

Enrollment begins on Oct. 15 and ends on Dec. 7.

2. Do Your Homework

Begin researching Medicare Part D plans right away so you have time to make an informed decision.

Consider the premium, deductible and copyments when assessing the overall cost of the plan. Make sure that the drugs you need are on the plan's formulary (the list of covered medications).

Look at the plan’s network of pharmacies. Some plans, such as the Express Scripts Medicare Choice Plan, offer a preferred pharmacy network, which could save you money. Also consider that your medications may not be covered or will cost you more if you go to an out-of-network pharmacy. Plans with home-delivery options can save money and provide added convenience.

      3. Value Care and Convenience

      Consider a plan with round-the-clock pharmacist access to help you get the support you need and the savings you want from your plan. Pharmacists can identify shortcuts to help you stick to your treatment regimen and avoid potentially harmful drug interactions.

      Also consider a plan’s Star Rating. CMS assesses and rates Medicare plans every year on how well they perform in several categories such as customer satisfaction and medication safety. The Medicare star ratings range from 1 star (poor) to 5 stars (excellent).

      Making the Most of Your Medicare Dollars

      To achieve the most value from your Part D plan, take your medications as prescribed, use generic medications when clinically appropriate, and take advantage of the free preventive screening and vaccinations under Medicare Part B.

      Seniors can visit to learn more about the Medicare Part D plans available in their region.

      Also, the Express Scripts free eGuide, Navigating Medicare and Reform: A Roadmap for Seniors and Caregivers, can help and is available at

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