Medicare Prescription Drug Coverage

Have Medicare and want better prescription drug coverage? Medicare Prescription Drug Coverage can help lower costs and give you greater access prescription drugs.

What is Medicare Prescription Drug Coverage?

Medicare offers prescription drug coverage for everyone with Medicare, called Part D. This coverage is designed to 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.

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.

How Can I Get Medicare Prescription Drug Coverage?

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:

• Original Medicare
• Some Medicare Private Fee-for Service Plans
• Some Medicare Cost Plans
• 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.

What Are Medicare Health Plans that Cover Drugs?

Medicare Advantage Plans and other Medicare Health Plans often cover prescription drugs.

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 Original Medicare, 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.

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:

• 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
• If you enter, live in, or leave a nursing home

How Do I Enroll?

Visit medicare.gov, or call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

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