About Medicare Prescription Drug Coverage
Medicare's prescription drug coverage (also called Part D) is a program to help people on Medicare pay for medicine. You can add Part D to Original Medicare. It can also be added to certain other Medicare plans. You can also get prescription drug coverage by enrolling in a Medicare Advantage Plan that offers it.
Most people who are 65 years and older or are disabled can enroll in Medicare. This includes Medicare drug plans.
When to Enroll
You can enroll in Medicare 3 months before your 65th birthday or 3 months after. People who are disabled can enroll during a 7 month window around their 25th month of disability. Medicare also has an open enrollment period from October 15 through December 7.
What it Covers
Private health insurance companies manage the drug plans for Medicare. They 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 when a generic one can be found. However, if there is a medicine that you really need, your doctor may be able to appeal and get it covered.
What it Costs
The costs depends on many things, such as the medicines you use, the plan, and whether you go to a pharmacy in your plan’s network. Here are some costs you can expect to pay:
- Monthly premium—This is the monthly fee that drug plans charge.
- Yearly deductible—This is the amount of money you must pay for prescriptions before the plan begins to pay.
- Co-payments—This is the amount you pay at the pharmacy for your covered prescriptions after the deductible has been met.
- Coverage gap—Most drug plans have a coverage gap. You have to pay all costs out-of-pocket for your medicines up to a yearly limit after you and your drug plan have spent a certain amount of money for your covered medicines.
- Catastrophic coverage—After you have spent up to your plan’s out-of-pocket yearly limit, this allows you to only pay a small co-payment for the drug for the rest of the year.
- Late enrollment penalty—This penalty is added to your Part D premium if you have a period of time when you have not been covered by Part D or another prescription drug plan.
Ways to Lower the Cost
There are steps that you can take to lower your costs, such as:
- Switching to a generic medicine or less expensive brand-name
- Finding out if your state offers a prescription assistance program.
- Applying for help through Medicare and Social Security
Making the Decision
By answering a few questions, you should be able to choose a plan that works best for you:
- What drugs are you taking now? Does the Medicare plan you are looking at cover most of the costs for those drugs?
- Does the pharmacy you use carry the drugs that are covered by the plan? Ask your pharmacist for help.
- How much can you afford to spend?
- Do you have all the information about other insurance coverage you may have?
- Is the plan you are looking at flexible enough to change if your health changes?
Where to Find Out More
Visit the US Medicare website to learn more about their health plans and drug coverage. If you are eligible, you can even sign up for Part D online.
Drug coverage (Part D). Medicare website. Available at: https://www.medicare.gov/drug-coverage-part-d. Accessed October 19, 2021.
Enrolling at the right time. AARP website. Available at: http://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-enrollment.html. Accessed October 19, 2021.
Extra help with Medicare prescription drug plan costs. Medicare website. Available at: https://secure.ssa.gov/i1020/start. Accessed October 19, 2021.
Get help paying costs. Medicare website. Available at: https://www.medicare.gov/your-medicare-costs/get-help-paying-costs. Accessed October 19, 2021.
Medicare Advantage plans. Available at: https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans. Accessed October 19, 2021.
Medicare and you: 2022. Medicare website. Available at: https://www.medicare.gov/Pubs/pdf/10050-Medicare-and-You.pdf. Accessed October 19, 2021.
Last reviewed October 2021 by EBSCO Medical Review Board Last Updated: 10/19/2021