Medicare Drug Plan

  • What is Medicare Prescription Drug Coverage

    IMAGE Medicare's prescription drug coverage (also called Part D) is a program to help people on Medicare pay for medications. You can add Part D to Original Medicare, as well as to certain other Medicare plans. Another way that you can get prescription drug coverage is to enroll in a Medicare Advantage Plan that offers drug coverage.
  • Who Is Eligible?

    Most people who are 65 years and older or are disabled can enroll in Medicare, including Medicare drug plans.
  • When Should I Enroll?

    You can enroll in Medicare around your 65th birthday—three months before your birthday month to three months after. If you have a disability, you can enroll during a seven-month window around your 25th month of disability. Also, Medicare has an open enrollment period from October 15 through December 7.
  • What Does It Cover?

    Private health insurance companies administer the drug plans for Medicare. These companies provide a list of brand-name and generic drugs that they cover. The list can change over time. It is common for drug plans to exclude more expensive brand-name medications if a generic one is available. However, if there is a medication that you really need, your doctor may be able to appeal and get the drug covered.
  • What Does It Cost?

    The costs depends on different things—the medications you use, the plan you choose, and whether you go to a pharmacy in your plan’s network. Here are some costs you can expect to pay:
    • Monthly premium—This is the monthly fee that drug plans charge.
    • Yearly deductible—This is the amount of money you must pay for your prescriptions before your plan begins to pay.
    • Co-payments—This is the amount you pay at the pharmacy for your covered prescriptions after the deductible has been reached.
    • Coverage gap—Most drug plans have a coverage gap. After you and your drug plan have spent a certain amount of money for your covered medications, you have to pay all costs out-of-pocket for your prescriptions up to a yearly limit.
    • Catastrophic coverage—After you have spent up to your plan’s out-of-pocket yearly limit for covered drugs, this allows you to only pay a small co-payment for the drug for the rest of the year.
    • Late enrollment penalty—This penalty is added to your Part D premium if you have a period of time when you have not been covered by Part D or another prescription drug plan.
  • Are There Ways to Lower the Costs?

    Yes, there are steps that you can take to lower your costs, such as:
    • Switching to a generic medication or less expensive brand-name
    • Finding out if your state offers a pharmaceutical assistance program.
    • Applying for help through and
  • How Should I Make My Decision?

    By answering a few questions, you should be able to choose a plan that works best for you:
    • What drugs are you taking now? Does the Medicare plan you are considering cover most of the costs for those drugs?
    • Does the pharmacy you use most often carry the drugs covered by the plan? Here, your pharmacist can help you to choose the right plan.
    • How much can you afford to spend on a drug plan?
    • Do you have all the information about other insurance coverage you may have?
    • Is the plan you are considering flexible enough to change if your health changes?
  • How Can I Get More Information?

    Visit to learn more about their health insurance plans and drug coverage. If you are eligible, you can even sign up online for Part D.
  • RESOURCES

    Medicare.gov http://www.medicare.gov

    Social Security http://www.ssa.gov

    References

    Drug coverage (Part D). Medicare.gov website. Available at: http://www.medicare.gov/part-d/. Accessed October 31, 2013.

    Enrolling at the right time. AARP website. Available at: http://www.aarp.org/health/medicare-insurance/info-04-2011/medicare-enrollment.html. Updated May 7, 2012. Accessed October 31, 2013.

    Extra help with Medicare prescription drug plan costs. Medicare.gov website. Available at: https://secure.ssa.gov/i1020/start. Accessed October 31, 2013.

    Get help paying costs. Medicare website. Available at: http://www.medicare.gov/your-medicare-costs/help-paying-costs/get-help-paying-costs.html. Accessed October 31, 2013.

    Medicare Advantage plans. Available at: http://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/medicare-advantage-plans.html. Accessed October 31, 2013.

    Medicare and you: 2014. Medicare website. Available at: http://www.medicare.gov/Publications/Pubs/pdf/10050.pdf. Accessed October 31, 2013.

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