Medicare offers prescription drug coverage (Part D) to everyone with Medicare. Medicare Part D plans are offered by private companies to help cover the cost of prescription drugs. Everyone with Medicare can get this optional coverage to help lower their prescription drug costs. Medicare Part D covers both brand-name and generic prescription drugs at participating pharmacies.
THERE ARE TWO WAYS TO GET MEDICARE PRESCRIPTION DRUG COVERAGE:
Medicare Prescription Drug Plans. These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Medicare Advantage Plans (like an HMO or PPO) or other Medicare health plans that offer Medicare prescription drug coverage. You get all of your Part A and Part B coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”
Whatever plan you choose, Medicare drug coverage will help you by covering brand-name and generic drugs at pharmacies that are convenient for you. Each Part D plan has a formulary - a list of medications the plan will cover. This list may also be referred to as a drug list, prescription drug list (PDL), or a covered medications list (CML). Drug coverage varies from one plan to another, so if you are considering a Part D plan, you may wish to review the plan's Prescription Drug List to be sure it will meet your needs.
WHO CAN ENROLL IN MEDICARE PART D?
To join a Medicare Prescription Drug Plan, you must have Part A and/or Part B. If you would like to get prescription drug coverage through a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.
Important Note for Medicare Beneficiaries with Employer or Union Coverage:
If you have employer or union coverage, call your benefits administrator before you make any changes, or before you sign up for any other coverage. If you drop your employer or union coverage, you may not be able to get it back. You also may not be able to drop your employer or union drug coverage without also dropping your employer or union health (doctor and hospital) coverage. If you drop coverage for yourself, you may also have to drop coverage for your spouse and dependants.
HOW MEDICARE PART D PLANS WORK
Part D plans may have a monthly plan premium and a yearly deductible. These vary from plan to plan. You pay a portion of your drug costs, including a copayment or coinsurance. Costs vary depending on which drug plan you choose. Coverage options, including drug coverage, may vary from plan to plan.
You may be able to get Extra Help to pay for your prescription drug premium and costs. To find out whether you qualify for Extra Help, call:
1-800-MEDICARE ( 1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week.
The Social Security Administration, 1-800-772-1213 FREE (TTY users, call 1-800-325-0778FREE)
Your state Medicaid office
WHY JOIN A MEDICARE DRUG PLAN?
Even if you don’t take a lot of prescription drugs now, you should still consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you are first eligible, and you don’t have other creditable prescription drug coverage (for example from an employer or union that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage), you will likely pay a late enrollment penalty (higher premiums) if you join later.
Note: Discount cards, doctor samples, free clinics, drug discount Web sites, and manufacturer’s pharmacy assistance programs are not considered prescription drug coverage and are not considered creditable coverage.
AVOID THE LATE-ENROLLMENT PENALTY. JOIN WHEN YOU FIRST BECOME ELIGIBLE.
The Cost of Medicare Prescription Drug Coverage
Like other insurance, if you join a Medicare Part D plan, generally, you will pay a monthly premium, which varies by plan, and a yearly deductible for most plans. You will also pay a part of the cost of your prescriptions, including a copayment or coinsurance. Costs will vary depending on the prescriptions you use and which drug plan you choose, whether you go to a pharmacy in your plan’s network, whether your drugs are on the plan’s formulary and whether you qualify for Extra Help paying your Part D costs. Some plans may offer more coverage and additional drugs for a higher monthly premium.
If you have limited income and resources, you may quality for the following:
Extra Help paying for your Part D premium and other prescription drug coverage costs.
For More Information:
Call 1-800-MEDICARE ( 1-800-633-4227 FREE). TTY users call 1-877-486-2048 FREE, 24 hours a day/7 days a week.
Visit www.medicare.gov/Publications/Pubs/pdf/10126.pdf to view the brochure, “Get Help With Your Medicare Costs: Getting Started.” You can learn more by reading Medicare & You, the official government handbook about Medicare. You will need the free Adobe® Reader® software to download the files.
Download Medicare & You
THE MEDICARE PRESCRIPTION DRUG COVERAGE GAP (THE "DOUGHNUT HOLE")
You can learn more about the Original Medicare Plan and the Medicare program by reading “Medicare and You”, the official government handbook about Medicare.
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