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Medicare Drug Plan

What is Medicare Prescription Drug Coverage

Medicare's prescription drug coverage (also called Part D) is a program to help people on Medicare pay for medications. You can add Part D to Original Medicare, as well as to certain other Medicare plans. Another way that you can get prescription drug coverage is to enroll in a Medicare Advantage Plan that offers drug coverage.

Who Is Eligible?

Most people who are 65 years and older or are disabled can enroll in Medicare, including Medicare drug plans.

When Should I Enroll?

You can enroll in Medicare around your 65th birthday—3 months before your birthday month to 3 months after. If you have a disability, you can enroll during a 7-month window around your 25th month of disability. Also, Medicare has an open enrollment period from October 15 through December 7.

What Does It Cover?

Private health insurance companies administer the drug plans for Medicare. These companies provide a list of brand-name and generic drugs that they cover. The list can change over time. It is common for drug plans to exclude more expensive brand-name medications if a generic one is available. However, if there is a medication that you really need, your doctor may be able to appeal and get the drug covered.

What Does It Cost?

The costs depends on different things—the medications you use, the plan you choose, and whether you go to a pharmacy in your plan’s network. Here are some costs you can expect to pay:

Are There Ways to Lower the Costs?

Yes, there are steps that you can take to lower your costs, such as:

How Should I Make My Decision?

By answering a few questions, you should be able to choose a plan that works best for you:

How Can I Get More Information?

Visit the US Medicare website to learn more about their health insurance plans and drug coverage. If you are eligible, you can even sign up online for Part D.

RESOURCES:

Medicare
https://www.medicare.gov

Social Security
https://www.ssa.gov

REFERENCES:

Drug coverage (Part D). Medicare website. Available at: http://www.medicare.gov/part-d. Accessed August 23, 2017.

Enrolling at the right time. AARP website. Available at: http://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-enrollment.html. Updated July 29, 2015. Accessed August 23, 2017.

Extra help with Medicare prescription drug plan costs. Medicare website. Available at: https://secure.ssa.gov/i1020/start. Accessed August 23, 2017.

Get help paying costs. Medicare website. Available at: https://www.medicare.gov/your-medicare-costs/help-paying-costs/get-help-paying-costs.html. Accessed August 23, 2017.

Medicare Advantage plans. Available at: https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html. Accessed August 23, 2017.

Medicare and you: 2017. Medicare website. Available at: https://www.medicare.gov/pubs/pdf/10050-Medicare-and-You.pdf. Accessed August 23, 2017.

Last reviewed August 2017 by EBSCO Medical Review Board Michael Woods, MD, FAAP  Last Updated: 10/31/2013