Medicare is a federal health insurance program that helps eligible participants pay for certain healthcare costs. Medicare Part A is hospital insurance and Medicare Part B is medical insurance. Parts A and B combined are often called Original Medicare.
Medicare Part D is optional prescription drug coverage, but even if you forgo Part D coverage, many optional Medicare Advantage plans include prescription drug coverage.
How to Get Medicare Prescription Drug Coverage
There are two ways to get Part D prescription drug coverage if you are eligible for Original Medicare:
- Purchase Part D coverage when you sign up for Parts A and B. Part D coverage may be appropriate even if you aren’t currently taking prescription drugs. Part D coverage requires a monthly premium payment and is offered to everyone with Original Medicare. If you don’t sign up when you are first eligible for Original Medicare, you may pay a late enrollment penalty if you decide to sign up later.
- Choose a Medicare Advantage (MA) plan, also called Part C, that includes prescription drug coverage. MA plans are designed to help cover out-of-pocket healthcare costs for people with Original Medicare. These plans are provided by private health insurance companies and are regulated by Medicare.
How Does Medicare Drug Coverage Work?
Medicare Part D covers commonly used medications and many drugs used to treat severe medical conditions. All plans must follow Medicare’s guidelines, but it’s essential to evaluate your choices carefully, since plan coverage may vary. A plan’s list of covered drugs is called a “formulary,” and each plan has its own formulary.
Medicare places each prescription drug into one of three tiers with different out-of-pocket costs. Ask your agent to help you review your current list of medications before choosing prescription drug coverage so you understand your potential out-of-pocket costs.
When to Join, Switch or Drop Prescription Drug Coverage
In general, you can join, switch or drop a Medicare Part D or MA plan with drug coverage during these times:
- Open enrollment period from October 15 to December 7 each year.
- Initial enrollment period when you first become eligible for Medicare.
- Medicare Advantage open enrollment period from January 1 to March 31 each year if you currently have a MA plan. You can join a different MA plan or switch to Original Medicare and purchase Part D insurance once during this time.
Evaluate Your Medicare Advantage Options
Choosing the right prescription drug coverage can be challenging. Contact Wimmer Insurance in Detroit Lakes, Minnesota, today to speak with a Medicare Advantage expert.
This blog is intended for informational and educational use only. It is not exhaustive and should not be construed as legal advice. Please contact your insurance professional for further information.