Medications prescribed by a doctor can improve your health and may even save your life, but without any insurance, the costs can be devastating. Most Medicare recipients are on a limited budget because they are already retired or planning ahead to the future. Unexpected prescription drug costs can threaten your financial security, especially if you are diagnosed with a chronic illness that will require medications long-term. If you qualify for Medicare, you can get help paying for prescription drugs you need, but you should understand your options.
When you qualify for Medicare, you have decisions to make. Most people qualify for premium-free Medicare Part A (Hospital Insurance) at 65 years of age if they have worked and paid taxes for a certain period of time. Many Medicare recipients choose to enroll in Part B (Medical Insurance) when they are first eligible to avoid paying late enrollment penalties when they decide to sign up after their initial enrollment period has ended. Part B includes coverage for preventive care and medically necessary services and supplies. While Part A and Part B benefits can help cover many medial expenses, your out-of-pocket costs can add up. Many Medicare recipients purchase a Medigap, or Medicare Supplement, policy to help cover the costs that Original Medicare does not, including copayments, coinsurance, or deductibles. Unfortunately, Part A, Part B, and Medigap do not include any coverage for prescription drugs.
Enrolling in a Prescription Drug Plan
Medicare Part D prescription drug coverage can help cover the costs of medications prescribed by your physician, but you have choices. If you have Original Medicare Part A and/or Part B, you can enroll in a stand-alone Prescription Drug Plan (PDP). PDPs are sold by private insurance companies and each plan will have its own formulary, or list of covered drugs. Prices can vary greatly from plan to plan, with individual tiers of pricing based on whether you purchase generic or brand name drugs and if you visit an in-network pharmacy or use a mail order service. Compare plans before enrolling, and if you already have a need for specific medications, check plan formularies before choosing a PDP.
Medicare Advantage Plans with Prescription Drug Coverage
Instead of getting your Medicare benefits through Original Medicare, individuals eligible for Medicare can choose to enroll in a Medicare Advantage (MA) plan. Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide your Part A and Part B coverage. Many MA plans offer additional coverage, including prescription drug coverage. Medicare Advantage plans vary in cost and coverage, and each plan will have its own formulary, or list of covered drugs.
Medicare Part D: Medicare Prescription Drug Coverage