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Medicare Prescription Drug Coverage

Medicare Part D

Medicare Part D is an optional program that helps pay for prescription drugs. It does this through a variety of plans offered by private companies that have been approved by Medicare. Part D is often called the “Medicare Prescription Drug Program.

Medicare Prescription Drug Coverage offers:

  • Prescription drug coverage for everyone with Medicare regardless of income and resources, health status, or current prescription expenses;
  • Both brand name and generic prescription drugs at participating pharmacies convenient to beneficiaries;
  • Protection for people who have very high drug costs or from unexpected prescription drug bills in the future.

You may be able to get help with your costs to have Medicare prescription drug coverage if you have limited income and resources. This program is called LIS/Extra Help. Unless you qualify for LIS/Extra Help, Medicare Part D is designed to share the costs of prescription drug coverage with you, not pay all of your medicine costs.

Medicare Prescription Drug Plans

Medicare drug plans are offered by insurance companies and other private companies approved by Medicare. People can choose to join a Medicare drug plan that meets their needs based on coverage, cost, convenience, and customer service.

There are two types of Medicare Drug Plans:

  • Medicare Prescription Drug Plan (PDP) – These plans add drug coverage to the Original Medicare Plan and some other types of Medicare plans.
  • Medicare Advantage Plan (MAPD) – This is an HMO or PPO and other Medicare health plan that includes prescription drug coverage. You will get all of your Medicare coverage (Part A and B), including prescription drugs (Part D) through these plans.

Medicare drug plans cover generic and brand name drugs. To be covered by Medicare, a drug must be available only by prescription, approved by the Food and Drug Administration, used and sold in the United States and used for a medically accepted indication. Each plans will have a “formulary” that tells you which drugs are covered by the plan. Plans may require prior authorizations, step therapy and quantity limits.

When to enroll

  • When you turn 65 – You may sign up for Part D when first eligible for Medicare A and/or B which is three months before the month you turn age 65 until three months after you turn age 65.
  • When you receive Medicare due to a disability – If you receive Medicare due to a disability, you can join from three months before to three months after your 25th month of cash disability payments.
  • Annual Open Enrollment Period (Oct 15 – Dec 7) – If you do not enroll when you first were eligible for Medicare generally your next opportunity will be during the Annual Enrollment Period (AEP), October 15 thru December 7 with coverage starting January 1.
  • Penalty If you do not enroll when you are first eligible and go without creditable prescription drug coverage for 63 continuous days or more, you may have to pay a late enrollment penalty to join later. The penalty amount is based on when you join. It is added each month to your Medicare drug plan’s premium for as long as you have a plan.
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