How to Get Your Medications Covered & Save on Costs
Most people need prescription drug coverage to cover the high costs of medication. Original Medicare Part A and Part B don’t include prescription drug coverage.
So, Medicare offers an optional benefit for prescription drug coverage, Medicare Prescription Drug Plan (PDP)
Medicare Part D is offered by Medicare-approved private insurance companies. To qualify for Medicare Part D, you need to be eligible for Medicare Part A and/or Part B, and a resident of the PDP service area.
Do you have to enroll in Medicare Part D?
No. Coverage in Medicare Part D is optional, but if you don’t enroll as soon as you are eligible, you may end up paying a late-enrollment penalty later.
If you have Original Medicare and do not have any existing prescription drug coverage, you can:
- Participate in Medicare Part D to add drug coverage to your plan
- Switch from Original Medicare to a Medicare Advantage Plan (Medicare Part C) that includes prescription drug benefits. Medicare Advantage includes Medicare Parts A and B and often includes prescription drug coverage, as well as additional benefits (such as vision, hearing and wellness coverage). Medicare Advantage must be purchased from a private insurance agency.
If you already have prescription drug coverage through one of the following programs, it may not be in your best interest to enroll in Medicare Part D:
- Federal Employee Health Benefits (FEHB) Program
- Veteran’s Benefits
- TRICARE (military health benefits)
- Indian Health Services
See how Part D works with other insurance you may have and determine if Medicare Part D is right for you.
How to Choose a Medicare Prescription Drug Plan
There are many Medicare-approved PDP options for you to choose from and it’s important to pick the best one for you. When comparing plans, here are some things to consider:
- If there are specific drugs you need to take, make sure those drugs are included on the plan’s list of prescription drugs that are covered, then compare costs for those drugs between plans.
- If you need extra protection from high drug costs, look for plans that offer coverage in the coverage gap. Make sure your drugs are included.
- If you need your drug costs to be balanced throughout the year, seek out plans with low or no deductible.
- If you take a lot of generic medications, find policies that have drug tiers that charge little or nothing for generic drugs.
- If you aren’t taking many drugs now, consider a plan with a low premium, just so you have coverage if you ever need it.
- If you want extra benefits and lower costs by getting your healthcare coverage and prescriptions through a single plan, and don’t mind restrictions on your health care providers, a Medicare Advantage Plan with prescription drug coverage might be right for you.
Note: If you have a Medicare Advantage Plan that has prescription coverage, and you join Medicare Part D, your Medicare Advantage Plan will go back to Original Medicare.
Help Paying Prescription Drug Costs
Costs you’ll have to pay when you get a Medicare Prescription Drug Plan will vary, but will likely include a monthly premium, a yearly deductible, co-pays or co-insurance and costs in the coverage gap.
There are lots of programs to help you save on prescription drug costs, if you qualify. These include Medicaid, Medicare Savings Programs, PACE, programs for people in US territories, Medicare Extra Help (Part D), CHIP (Children’s Health Insurance Program) and SSI (Supplemental Security Income). Explore these options and see if you qualify.
You may be able to lower your prescription drug costs on your own:
- Ask your doctor if you can switch your expensive brand-name drugs for generics or lower-cost brands
- Use mail-order pharmacies
- Find out if the drug manufacturer that makes your specific drug offers discounts or assistance programs
- See if your state offers pharmaceutical assistance programs
If you have Original Medicare and regularly take prescription drugs, you should explore the plans available to you under Medicare Part D to determine which plan best meets your individual needs.