Medicare Part C vs Part D: A Pharmacist’s Guide to Helping Patients Navigate Coverage Options

Navigating the nuances of Medicare can be a challenge for anyone in the medical profession.

However, expecting our patients to do it on their own is not only unfair, it may also result in losing a valued part of our pharmacy clientele.

As highly-trained healthcare providers, pharmacists can serve as a resource for seniors navigating coverage options. .

Pharmacists: Your Expertise is Key to Patient Health

Expertise in complex medication management and drug interactions to patient counseling and preventive care, your training equips your business with the necessary skills to ensure optimal health outcomes.

We are well-versed in the latest advancements in pharmacotherapy, clinical guidelines, and evidence-based practices.

All of this said, one fact remains: The United States Medicare system is complicated and ever-changing. Despite all of our training and hard work, we must strive to stay current for the success of our pharmacy practice and for our patients’ well-being.

Fortunately, there are resources available to help you achieve these goals.

Medicare Part C: What it is and How it Affects Your Patients

Let’s start with the basics:

What is Medicare Part C?

Simply put, Medicare Part C, also known as Medicare Advantage, is an alternative to original Medicare.

These plans are offered by private health insurance companies that have been pre-approved by Medicare.

They combine the benefits of Medicare Part A (nursing care and in-patient hospital stays) and Medicare Part B (regular provider visits) into one plan.

Medicare Advantage plans are popular for seniors in order to maintain comprehensive coverage. Many include additional benefits such as vision, dental, hearing, wellness programs, and even medications.

It’s common for a Medicare Advantage plan to include Medicare prescription drug coverage (Part D), which helps cover the cost of medications.

Who’s a Good Candidate for Medicare Part C?

Medicare Part C can be a great option for many of your patients.

In fact, a study done in 2023 showed that slightly over half, or 51%, of the eligible Medicare population is now enrolled in Medicare Part C plans.

Medicare Part C plans are appealing with their options. Original Medicare involves combining Part A and Part B in order to obtain full medical coverage. For most Seniors, this will typically cost a monthly premium of $150-200, and can be deducted directly from their Social Security check.

Additionally, most people will also purchase Medicare Part D, which covers prescription drugs as well.

In contrast, Medicare Advantage plans (which are purchased through a private health plan) offer the benefits of Parts A and B, (and often D), for a similar cost but with lower copays.

Remember: many of these plans also include those extra benefits not covered by original Medicare, such as fitness memberships, vision, and dental care.

However, it’s important to make sure your patients see the full picture before they rush to sign up for a Part C Medicare Advantage plan.

Many of these private insurance company plans can carry hidden risks, particularly for people with major health issues. And they may charge more or not cover medical care from certain providers who aren’t in their private network.

Medicare Part D: Who Needs it and Why

Medicare Part D is a voluntary prescription drug plan offered by private insurance companies.

It is designed to help cover the cost of medications that patients would typically get from a pharmacy unlike those administered in a hospital or doctor’s office, which are covered under original Medicare (Parts A and B).

Who Needs Medicare Part D?

According to a 2019 report by KFF.org, 89% of adults over 65 years old are taking at least one prescription drug on a regular basis. Additionally, KFF also reports that in 2022, Medicare beneficiaries spend a greater proportion of their income on health care costs (13.6%) than those under the age of 65 (6.5%).

Medicare Part D is an elective prescription coverage program and it’s an helpful benefit for many of your older patients who:

• Have High Prescription Drug Costs: If a patient regularly takes prescription medications, especially expensive ones, Medicare Part D can significantly reduce their out-of-pocket costs.
• Have Chronic Conditions: Those with chronic health conditions that require ongoing medication management will benefit from the coverage provided by Part D.
• Have a Medigap Plan: If a patient has a Medicare Supplement (Medigap) plan, Part D can complement their coverage by handling prescription drug costs that Medigap plans do not cover.

• Want Plenty of Comprehensive Coverage: Even if a patient does not currently take any medications, enrolling in Part D can provide them with peace of mind and financial protection against future prescription drug costs.

Medicare Part D provides essential prescription drug benefits for anyone looking to manage their medication costs effectively, especially those with chronic conditions or high medication expenses.

It offers broad coverage, cost savings, and flexibility, making it a necessary addition to seniors’ healthcare plan.

Providing the Path: How Pharmacists Can Help Patients with Medicare Get the Care They Need

Navigating the complexities of Medicare can be daunting for many beneficiaries. The variation among plans, the sheer number of options, and the fluctuating medication costs across different phases of the benefit often lead to suboptimal plan selections.

Studies have shown that many beneficiaries end up spending more than necessary on their coverage, in large part because they don’t have a support resource  to educate them effectively. Brokers are common in this space to help seniors navigate the options in their region and incorporate considerations like current conditions, travel plans, and health outlook in the coming year.

As a pharmacist, you are uniquely positioned to assist your patients in navigating their Medicare challenges, which can be an optimal outcome for both them and you.

These efforts help patients achieve better health outcomes and cost savings and enhance the pharmacist’s role as a trusted healthcare provider in the community.

Pharmacists are front-line providers in assisting patients in various aspects of patients’ medical insurance needs.

Your ongoing expertise will help your patients be healthier and more satisfied with their healthcare coverage.

And ultimately, be more satisfied with you.

Helping Pharmacists Help Patients: DocStation Has Arrived

Pharmacists have long been asked to do more for less.

Ranging from managing medication therapy to providing patient counseling, the role of a pharmacist has expanded well beyond dispensing and into the world of patient care.

While pharmacists have quickly embraced this increased responsibility, their compensation and support haven’t kept up with the pace.

However, DocStation is here to change that.

DocStation isn’t just a software solution —it’s a movement towards a more rewarding and less stressful future in pharmacy.

By automating tasks and optimizing workflows, DocStation liberates pharmacists from much of the administrative burden, enabling them to focus on personalized patient care and advanced provider-status activities.

DocStation helps you reconnect with the passion which initially led you to pharmacy school in the first place.

Here are just a few ways that DocStation can help you:

• Create a Comprehensive Electronic Health Record System: Pharmacies use our EHR to manage patient care efficiently, ensuring all patient information is organized and accessible.
• Auto-Bill for Services: Our software can automatically bill for services provided, reducing the administrative burden and ensuring timely compensation.
• Participate in Payer-Sponsored Programs: Engage in programs sponsored by payers to enhance patient care and outcomes.

• Connect Pharmacies with Payers: DocStation helps facilitate collaboration between pharmacies and payers to deliver care, improve health outcomes, and reduce costs.
• Design Population Health Tools for Payers: Payers can use our integrated tools to design, launch, and scale innovative clinical programs, enhancing overall population health.
• Align Incentives and a Seamless User Experience: Ensure that all stakeholders are aligned and can focus on what matters most—the patient—through a seamless and intuitive provider and administrator experience.

By simplifying administrative tasks and ensuring fair compensation, DocStation is set to propel the pharmacy profession into a new era.

Are you interested in the next revolution in pharmacy-driven healthcare?

Contact DocStation today and find out how you can help improve your patient’s health and your profits at the same time.