What is Medicare prescription drug coverage?

Medicare prescription drug coverage is insurance that covers both brand-name and generic prescription drugs at participating pharmacies in your area. Medicare prescription drug coverage provides protection for people who have very high drug costs.

Who can get Medicare prescription drug coverage?

Everyone with Medicare is eligible for this coverage, regardless of income and resources, health status, or current prescription expenses.

When can I get Medicare prescription drug coverage?

Everyone is eligible in their “Initial Election Period” when they “age-in” to Medicare, no matter what time of year that may be. Some are also eligible at whatever time of year they encounter a “Special Enrollment Period” (i.e. leaving Employee Group Health Plan, moving out of plan’s service area, etc.) Otherwise, you may sign up from November 15th to December 31st each year during the “Annual Election Period” (AEP). With the AEP, coverage starts January 1st the following year. If you don't sign up when you are first eligible, you may pay a penalty if later you decide to enroll and your next opportunity to enroll would be in the next “Annual Election Period”.

How does Medicare prescription drug coverage work?

Your decision about Medicare prescription drug coverage depends on the kind of health care coverage you have now. There are two ways to get Medicare prescription drug coverage. You can join a Medicare prescription drug plan or you can join a Medicare Advantage Plan or other Medicare Health Plan that offers drug coverage.

Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you. Many feature mail-order benefits and discounts for purchasing three months supplies All plans have a list of covered medications, called a “formulary”, which will show which drugs are covered and which tier the drug will fall under in that specific plan.

Like other insurance, you pay the plan’s premium, which varies by plan, and you cost-share with the plan company. Some plans include a yearly deductible (generally $275), some do not. After deductibles are met (if there is one) you will also pay a part of the cost of your prescriptions (copayment). Costs will vary depending on which drug plan you choose. Some plans may offer more coverage and additional drugs for a higher monthly premium. It is wise to review your choice of plans each November as these plans can change every year.

Why should I get Medicare prescription drug coverage?

Medicare prescription drug coverage provides greater peace of mind by protecting you from unexpected drug expenses. Even if you don't use a lot of prescription drugs now, you should still consider joining. As we age, most people need prescription drugs to stay healthy. For most people, joining now means protection from unexpected prescription drug bills in the future.

What if I have a limited income and resources?

There is extra help for people with limited income and resources. Almost 1 in 3 people with Medicare will qualify for extra help. Medicare will pay for almost all of their prescription drug costs. You can apply or get more information about the extra help by calling Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visiting http://www.socialsecurity.gov/prescriptionhelp/.

Visit the Medicare Prescription Coverage Home Page