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Does Medicare Pay for Prescription Drugs?

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Does Medicare Pay for Prescription Drugs?

Tuesday, January 16, 2018 7:19 AM

Does Medicare Pay for Prescription Drugs?

When becoming eligible for Medicare, many Medicare beneficiaries make the mistake of thinking they automatically get prescription drug coverage. This is not the case. Original Medicare (Part A and Part B) does not cover prescription drugs. If you want prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Medicare recipients can get prescription drug coverage one of two ways:

Medicare Advantage Plan (Part C): Medicare Advantage plans not only provide all of the same coverage as Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), they also generally offer additional benefits, such as vision, dental, and hearing, and prescription drug coverage. Medicare Advantage Plans that include prescription drug coverage are sometimes called “MA-PDs” and may include an amount for drug coverage in the monthly premium.

This “all-in-one” coverage can combine your hospital, medical, and prescription drug coverage into one plan. Therefore, you would use one single Medicare card from the insurance provider instead of the red, white, and blue Original Medicare card.

Compare Medicare Advantage Plans with prescription drug coverage that contract with Medicare.org here.

Medicare Prescription Drug Plan (Part D): Medicare Part D, also called the Medicare prescription drug benefit, and sometimes called "PDPs” can be added to your Original Medicare (Part A and/or Part B) coverage. Medicare Prescription Drug Plans typically charge a monthly fee that varies by plan and is paid in addition to your Part B premium. Therefore, in addition to your red, white, and blue Medicare card, you will receive a separate prescription drug card from the private insurance company.

You cannot have both a Part D Plan and a Medicare Advantage Plan. If you join a Part D plan, your Medicare Advantage Plan will disenroll you and you’ll return to Original Medicare.

Compare Prescription Drug Plans that contract with Medicare.org here.

Medicare Part D Penalty for Late Enrollment

All eligible Medicare beneficiaries have a seven-month Initial Enrollment Period (IEP) when they can enroll in Medicare Part A and/or Part B, as well as sign up for a Medicare Advantage Plan (Part C) and/or a Medicare Prescription Drug Plan (Part D). The IEP starts 3 months before you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.

If you enroll in a Medicare Prescription Drug Plan (whether through Medicare Part D or a Part C plan that includes prescription drug coverage) after your Initial Enrollment Period (IEP), you may have to pay a late-enrollment penalty. 

According to Medicare.gov, the cost of the late enrollment penalty depends on how long you went without Part D or creditable prescription drug coverage.

Medicare calculates the penalty by multiplying 1 percent of the "national base beneficiary premium" ($35.02 in 2018) times the number of full, uncovered months you didn't have Part D or creditable coverage. The monthly premium is rounded to the nearest $.10 and added to your monthly Part D premium. The national base beneficiary premium may increase each year, so your penalty amount may also increase each year.

Yearly Enrollment Periods for Part C and Part D

Did you miss your Initial Enrollment Period, but need prescription drug coverage? Would you like to make changes to your current prescription drug coverage? Each year, from October 15th – December 7th, you can make changes to parts of your Medicare coverage – which includes changes to your prescription drug coverage – during Medicare’s Annual Enrollment Period (AEP). Here’s what you can do during AEP:

  • Change from Original Medicare to a Medicare Advantage Plan or vice versa.
  • Switch from a Medicare Advantage Plan to a different Medicare Advantage Plan, or switch to a Medicare Advantage Plan that does or does not offer drug coverage.
  • Join a Medicare Prescription Drug Plan (Part D) or switch from one Medicare drug plan to another Medicare drug plan.
  • Drop your Medicare prescription drug coverage completely.

Compare Medicare Part D Plans

Are you looking for prescription drug coverage? Medicare.org offers free, accurate comparisons for Medicare Prescription Drug Plans (Part D) and Medicare Advantage Plans (Part C), including Medicare Advantage Prescription Drug Plans (MA-PD). We can also help you find Medicare Supplement (Medigap) coverage to help pay for the out-of-pocket costs that Original Medicare doesn’t cover.

Contact a Medicare.org licensed sales agent at (888) 815-3313 - TTY 711 to help you find the right Medicare coverage for your needs. 

Related Information: 

Original Medicare or Medicare Advantage? 4 Questions to Help You Choose

10 Reasons to Consider a Medicare Advantage Plan

The Pros of Using a Medicare Agent to Find a Plan

How to Compare Medicare Plans at Medicare.org

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Last Revised 11/15/2017