| Tue, Nov 26, 2013 @ 09:00 AM

Medicare Prescription Drug Coverage Basics

Posted by Medicare Made Clear

prescription drug plansIf you have Medicare and want prescription drug coverage, you have two choices. You can get a standalone Medicare Part D prescription drug plan or you can get a Medicare Advantage (Part C) plan that includes drug coverage. Original Medicare (Parts A and B) does not cover prescription drugs. Many people who choose Original Medicare also purchase a standalone Medicare prescription drug plan.

Fairly clear, right?

Where it may get confusing is when you start shopping for plans, because coverage and costs may vary widely.

Shopping for Prescription Drug Coverage

When comparing prescription drug plans, you need to consider more than just the monthly premium amount, if any. You also need to understand what other out-of-pocket costs you may have.

Start by creating a list of the drugs you take. Then add up what you spent for these drugs in the last 12 months. Use this information as you ask the following questions:

  • Are the drugs you take on the plan’s list of covered drugs, also known as a formulary? Formularies are often tiered. Pay attention to what tier your drug is in. In general, the lowest-tier drugs are the lowest cost.
  • What would you have paid under this plan in comparison to what you paid for your drugs over the past 12 months? Use each plan’s cost-sharing amounts (copays and coinsurance) to estimate your costs.
  • Does the plan have a pharmacy mail-order program? In addition to convenience, getting your refills by mail may help reduce your out-of-pocket costs.
  • If the plan has a pharmacy network, is your pharmacy in it? Your costs will likely be lower if you use a pharmacy that’s in your plan’s network.

When You Can Enroll or Switch

You can sign up for prescription drug coverage when you first become eligible for Medicare. Your Initial Enrollment Period (IEP) is seven months long. It starts three months before your eligibility month, includes your eligibility month and lasts for three months after your eligibility month. If you sign up outside of your IEP, you may have to pay a penalty, unless you qualify for an exception.

Each year during Medicare Open Enrollment, October 15 – December 7, you may switch from one prescription drug plan to another, or from one Medicare Advantage plan that includes drug coverage to another. You may also join a new prescription drug plan if you decide to switch from a Medicare Advantage plan to Original Medicare. There are no penalties as long as you have not been without creditable drug coverage for more than 63 days.

You may also drop your drug coverage completely during Medicare Open Enrollment, but you may have to pay a penalty if you decide you want it again later.

For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.


Medicare.gov: Visit the official government website for the Centers for Medicare and Medicaid Services and use their plan finder tool.

Y0066_131111_104623 Accepted