Understanding Medicare drug plans

Here’s what you should know as you consider Medicare prescription drug coverage (Part D).

Medicare prescription drug coverage (Part D) adds to your Medicare health coverage by paying for both the brand-name and generic drugs that you get at the pharmacy. Here’s what you should know as you consider Medicare drug plans.

Doesn’t Medicare cover prescription drugs?
Medicare Part B (medical insurance) includes very limited drug coverage — such as injections you get in a doctor’s office, certain oral cancer drugs and flu shots. You’ll need a prescription drug plan to get insurance coverage for most of the drugs you get at the pharmacy — such as medication for an illness or a chronic condition.

What are the differences among plans?
Medicare drug plans are offered by insurance companies and other private companies. All Medicare drug plans are approved by Medicare and must include a standard level of coverage. However, plans may offer different combinations of coverage and cost sharing. Potential differences include what drugs are covered, how much you have to pay and which pharmacies you can use.  

Enrolled in Original Medicare?
If you are enrolled in Original Medicare (Part A or Part B), you can enroll in a Medicare prescription drug plan (often called PDP or Part D) to strengthen your coverage. You can also add a drug plan to some Medicare Private Fee-for-Service (PFFS) Plans, some Medicare Cost Plans and Medicare Medical Savings Account (MSA) Plans.

Enrolled in Medicare Advantage?
If you are enrolled in Medicare Advantage, you may have coverage for prescription drugs (Part D) as part of that plan. That means you won’t need an additional supplemental drug plan.

What is the “donut hole”?
As you evaluate plans, consider the costs for the copays, deductibles and coverage gap. The coverage gap, also known as the “donut hole,” is the period of time when you pay more of the cost for your drugs out-of-pocket — up to a limit. This gap starts when you and your plan have paid a set dollar amount for prescription drugs during that year. The coverage gap is gradually shrinking so that your Medicare drug coverage will be more reasonably priced.

What drugs are covered?
Each prescription drug plan will list the drugs it covers; this drug list is called a formulary. All Medicare drug plans generally must cover at least two drugs per drug category. If drug lists change during the year, you will be notified 60 days before the change goes into effect.

When can I enroll?
You can join or switch Medicare drug plans between Oct. 15-Dec. 7 each year, with coverage beginning on Jan. 1 of the following year.

What if I have questions?
For details, visit Your Guide to Medicare Prescription Drug Coverage.

As always, you can trust our experts to answer all of your questions about Medicare. Just contact our Medicare Solutions specialists online or call 800-280-2583.