Medicare.gov Tutorial - Select Preferred Pharmacy or Pharmacies
Step 3 of 4 is where you will choose one or two preferred pharmacies in your area. If you only decide to choose one pharmacy at first, you can return back to this step and change pharmacies or select a second pharmacy. The Pharmacy Selection will also be stored along with your Drug List ID so you will have this information if you return at a later date.
Note: If you must use one particular pharmacy, check with your pharmacy to ensure that they accept your chosen Medicare Part D plan. We have seen unusual situations where a particular pharmacy was selected and yet one of the top three Medicare Part D plans shown within the Plan Finder was NOT actually accepted by the selected pharmacy (a passing system error that was later corrected).
So, if you must use a particular pharmacy, call your pharmacy and make sure that they accept the Medicare Part D plan that you have chosen — before enrolling into the plan.
No more skipping over Step 3 of 4 - please choose a Pharmacy!
In the past, the Medicare Plan Finder allowed us to skip Step 3 of 4 and typically we clicked on "I don't want to add pharmacies at this time" or continue or whatever button is available to move on the next step. We were not being lazy. We skipped this step because we figured that you would almost always have a nearby network pharmacy since most national Medicare Part D prescription drug plans have over 50,000 participating pharmacies in their network and the list of pharmacies continues to grow in almost every Pharmacy Network. But now, we usually choose two different local pharmacies representing national pharmacy chains to see if there is any variation in retail drug price (and there usually is).
Although we used to skip this step in the past, the pharmacy selection process can be really helpful and is very easy to use. This screen below shows that within one mile of this example ZIP Code 37920, there are over 14 pharmacies available and these pharmacies are listed on the page. If you wanted to broaden your search for a pharmacy, this page allows you to increase the number of miles away from the ZIP Code to find more pharmacies. You can also search for a pharmacy by name. If you are more map—oriented and wanted a geographic view of the pharmacies located in your area, you can also search for pharmacies by using the map function as shown in the screen down the page (just scroll down a little with your browser).
Why it is a good thing that you can no longer skip the Step 3 of 4 Pharmacy Selection.
There are several reasons why it is important for you to select one or two pharmacies where you will be using your Medicare Part D prescription drug coverage.
(1) If you are not real familiar with a new area, you may find that there are not too many participating pharmacies nearby. We have spoken with people who live in such a remote area of the country that they have access to only one local pharmacy and mail-order is perhaps not an option because of your chosen plan (for instance, if you live on an island in Puget Sound). For another example, see the screen below for people living in ZIP Code 83429 that contains only a single (yes, 1) pharmacy within the surrounding 20 miles.
Reason (2) and Reason (3) deal with costs: Retail Drug Costs and Plan Coverage Costs
(2) As mentioned in the box above, each pharmacy can have a different negotiated retail drug cost for the same medication and same Medicare Part D prescription drug plan. In fact, a Medicare Part D plan can (at least in theory) have a different negotiated retail price with every pharmacy in their network, although this would be unlikely. Still, you will definitely notice that some medications have a much different retail price at the various pharmacies in your area for the same medication and you can change pharmacies in this Step 3 of 4 to see the differences. (Note: The retail price is important because it determines when you reach the Donut / Doughnut Hole or Coverage Gap. In other words, when the total retail value of your drug purchases exceeds your Initial Coverage Limit, you go into the Donut Hole.)
(3) January 1st begins a new Medicare Part D plan year and every year has a whole new set of Medicare Part D and Medicare Advantage plans in your area. In recent years, you may have noticed that more Medicare Part D plan now separate network pharmacies into several classes that have different coverage pricing (such as, network pharmacies and preferred network pharmacies). Key point: You may find that some Medicare Part D plans provide lower costing coverage prices or cost sharing at preferred network pharmacies and higher prescription drug prices at non-preferred network pharmacies. For example, if you see that "pharmacy ABC" now sponsors the "ABC Medicare prescription drug plan", you may find that you get better coverage prices at an "ABC pharmacy" whey you use your "ABC Medicare Part D plan". So, if you do not accurately select your local or usual pharmacy, your actual annual prescription costs may be significantly higher than you expected. In other words, the price at your pharmacy may not be the price you see on the Medicare.gov Plan Finder if you choose a pharmacy that you do not actually visit. Also, in the unlikely event that your chosen pharmacy is not in a Medicare plan’s pharmacy network, the drug costs you will see in the Plan Finder are the full retail price of the drugs with no insurance coverage (again with emphasis — using a non-network pharmacy usually means you will pay full retail price for your medications).
If you choose to see a map view from the "Show / Hide Pharmacy Map" you will be given a view of your ZIP Code region with the pharmacies in the area. You can now move between the map and list view using the buttons provided above these sections. If you do not see any pharmacies on your map, you may need to increase the magnification with the (+) sign located to the right on the map surface. You can also use your mouse to move around the map to see pharmacies in nearby areas.
When we made this screen shot example, the map section only provided us with half of our local Saint Augustine Beach area. Maybe this map was somehow forecasting the storm surge from a direct hurricane strike or a particularly high tide. At any rate, we lost a number of our local Saint Augustine Beach pharmacies from the map. You may need to zoom in or zoom out or rely on the list view for a better representation of the pharmacies in your neighborhood
The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
Medicare has neither reviewed nor endorsed the information on our site.
We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information.
However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist.
For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year.
Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
Limitations, copayments, and restrictions may apply.
We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area.
However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service
area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048),
24 hours a day/7 days a week or consult www.medicare.gov.
When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare.
Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits
money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible.
The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll
during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the
Beneficiaries can appoint a representative by submitting CMS Form-1696.