Medicare Resources

What is Medicare Prescription Drug Coverage?

Medicare offers prescription drug coverage for everyone with Medicare. This is called “Part D.” This coverage may help lower prescription drug costs and help protect against higher costs in the future. It can give you greater access to drugs that you can use to prevent complications of diseases and stay well.

[For additional resources outside of the scope of this article, consider the following: RESOURCES]

If you join a Medicare drug plan, you pay a monthly premium. Part D is optional. If you decide not to enroll in a Medicare drug plan when you are first eligible, you may have to pay a penalty if you choose to join later.

Medicare drug plans are run by insurance companies and other private companies approved by Medicare.

There are two ways to get Medicare prescription drug coverage:

1. Join a Medicare Prescription Drug Plans that adds coverage to

• the Original Medicare Plan,
• some Medicare Private Fee-for Service Plans,
• some Medicare Cost Plans, and
• Medicare Medical Savings Account Plans

2. Join a Medicare Health Plan (like an HMO or PPO) that includes prescription drug coverage that is a part of the plan. You get all of your Medicare health care including prescription drug coverage through these plans.

Am I eligible for Medicare prescription drug coverage?

Medicare prescription drug coverage is available to everyone with Medicare.

What does the coverage offer?

• Medicare prescription drug coverage helps you pay for your prescription drugs.
• Medicare prescription drug coverage will cover generic and brand-name drugs.
• There is extra help for those who need it most.

How do the plans work?

• Medicare prescription drug plans provide insurance coverage for prescription drugs.
• Like other insurance, if you join you will pay a monthly premium that varies by plan and pay a share of the cost of your prescriptions.
• Costs and coverage will vary depending on the drug plan you choose.

Can I decide not to join?

• Joining is your choice. However, if you don’t join when you are first eligible, you may have to pay a penalty if you choose to join later.
• Like other insurance, you will have to pay this penalty as long as you have Medicare prescription drug coverage.

What are Medicare Prescription Drug Plans?

Medicare Prescription Drug Plans are offered by insurance companies and other private companies approved by Medicare.

They add coverage to:

• The Original Medicare Plan,
• Some Medicare Cost Plans,
• Some Medicare Private Fee-for-Service Plans, and
• Medicare Medical Savings Account Plans

With a Medicare Prescription Drug Plan:

• Generally, you pay less for your prescriptions
• You will get a plan member card after you enroll
• You use this card when you get your prescriptions filled
• You will pay the copayment, coinsurance, and/or deductible, if any

If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs

What are Medicare Health Plans that cover Drugs?

Medicare Health Plans (like HMOs and PPOs) often cover prescription drugs. Medicare Health Plans include:

1. Medicare Advantage Plans
2. Other Medicare Health Plans

Medicare Advantage Plans (like HMOs and PPOs) that include prescription drug coverage as part of the plan are health plan options that are approved by Medicare but run by private companies. They are part of the Medicare Program. If you join a Medicare Advantage Plan you are still in Medicare.

With Medicare Advantage Plans:

• You generally get all your Medicare-covered health care through that plan
• You may get extra benefits, such as coverage for vision, hearing, dental, and/or health and wellness programs
• You usually will have to pay some other costs (such as copayments or coinsurance) for the services you get. Out-of-pocket costs in these plans are generally lower than in the Original Medicare Plan, but vary by the services you use
• You may have to see doctors that belong to the plan or go to certain hospitals to get covered services
• You don’t need to buy a Medigap policy

Medicare Advantage Plans include:

• Health Maintenance Organizations (HMO),
• Preferred Provider Organizations (PPO),
• Private Fee-For-Service (PFFS) Plans,
• Medicare Medical Savings Account (MSA) Plans,
• Medicare Special Needs Plans (SNP),
• Other Medicare Health Plans

There are some types of Medicare Health Plans that include prescription drug coverage as part of the plan but that aren’t part of Medicare Advantage that are still part of the Medicare Program. With these plans, you generally get all your Medicare-covered health care through that plan.

Other Medicare Health Plans include:

• Medicare Cost Plans
• Demonstrations/Pilot Programs
• PACE (Programs of All-inclusive Care for the Elderly)

How Much Will the Plans Cost?

Your costs will vary depending on which drugs you use, whether you get extra help paying your Part D costs, and which Medicare drug plan you choose. Most drug plans charge a monthly premium that varies by plan. You pay this in addition to the Part B premium. Some drug plans charge no premium.

If you have limited income and resources, you may get extra help to pay for your Medicare drug plan costs.

Depending on what you can afford, you may be able to pick a pan with or without a monthly premium, deductible or coverage gap.

How do I Enroll?

You can enroll in three ways:

• Enroll online on this web site
• Call the plan directly
• Call 1-800-MEDICARE (1-800-633-4227) and Medicare will help you enroll. TTY users should call 1-877-486-2048.

Can I Change Plans After I Enroll?

Yes. You can change plans under certain circumstances:

• You can switch plans from November 15 through December 31 of every year
• In special circumstances, Medicare may give you an opportunity to switch to another plan. For example, if you permanently move out of your plan’s service area; if you get help from your state Medicaid program paying
•  Medicare premiums and/or cost sharing; if you qualify for extra help paying for prescription drugs; if the plan stops offering prescription drug coverage; or if you enter, live in, or leave a nursing home.

For More Information

• Read “The Facts About Medicare Prescription Drug Plans”
• Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
• Read the Medicare & You 2007 handbook mailed in October.

Cited Source:  The above statements, regulations, policies, procedures, forms, and laws are cited from HHS.gov and/or MEDICARE.gov, including but not limited to their agencies, departments, and affiliates). Any inaccuracies or misstatements should be brought to our attention immediately via the link which can be found at the bottom of each page. 

For up-to-date and official information please refer to one or all of the following: HHS.gov, MEDICARE.gov, SSA.gov.