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. If you join a Medicare drug plan, you usually 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 pay a penalty (see pages 47–48) if you choose to join later. These plans are run by insurance companies and other private companies approved by Medicare.
There are two ways to get Medicare prescription drug coverage:
- Join a Medicare Prescription Drug Plan that adds drug
coverage to the Original Medicare Plan, some Medicare Cost
Plans, some Medicare Private Fee-for-Service Plans, and
Medicare Medical Savings Account Plans. - Join a Medicare plan (like an HMO or PPO) that includes
prescription drug coverage as part of the plan. You get all of
your Medicare coverage through these plans, including
prescription drugs.
Both types of plans are called Medicare drug plans in this
section.
Medicare offers help to employers and unions to help pay for prescription drug coverage. If you have employer or union drug coverage, see page 61. Joining a Part D plan could end the retiree health benefits you and your family get. Talk to your benefits administrator.
How does it work?
After you have joined the Medicare drug plan you want, the plan will mail you membership materials including a plan member card you use when you get your prescriptions filled. When you use the card, you will pay the copayment, coinsurance, and/or deductible, if any.
In Medicare Advantage Plans that include Medicare prescription drug
coverage (Part D), your health care and drug usage is coordinated, with
an emphasis on preventive care to keep you healthy.
How much does it cost?
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 cover prescription drugs for little or no cost (see pages 64–65).
Your costs will vary depending on which drugs you use, which Medicare drug plan you choose, and whether you get extra help paying your Part D costs. Having a variety of plans to choose from gives you the chance to pick a plan that meets your unique needs. Choosing a plan that fits your situation allows you to get the coverage you want at the best price possible.
If you belong to a Medicare Advantage Plan (like an HMO or PPO) or a Medicare Cost Plan that offers Medicare prescription drug coverage, the monthly premium you pay to the plan includes an amount for prescription drug coverage. Some plans charge no premium.
You may be able to pick a plan with or without a monthly premium, deductible or coverage gap. To find the actual costs of the Medicare drug and health plans in your area, visit www.medicare.gov on the web. Select “Compare Medicare Prescription Drug Plans.” Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
