Choosing the Right Medicare Part D Prescription Drug Coverage
Basic Medicare (Part A and Part B) doesn’t include coverage for most prescription drugs you take at home. However, it’s impossible to be treated for most health conditions without the taking at least one prescription drug.
The good news is that Medicare has contracted with private insurance companies to offer consumers Medicare Part D for prescription drugs. Under Medicare Part D, there are different ways to get your Medicare prescription drug coverage and different private insurance companies to choose from. So how can you make sure you’re choosing the right plan for your needs?
Medicare Part D is what, exactly?
Medicare Part D is one of the “parts” of Medicare.
- Original (basic) Medicare is the traditional government health insurance program that includes Part A and Part B.
The other parts of Medicare are optional, and available from private insurance companies that contract with Medicare.
- Medicare Part C is the Medicare Advantage program. It gives you a way to get your Medicare Part A and Part B benefits through a private, Medicare-approved insurance company and may include extra benefits, like routine vision services.
- Medicare Part D is prescription drug coverage.
How can you get Medicare Part D benefits?
You can receive Medicare Part D coverage in either of these different ways:
- Through a Medicare Advantage Prescription Drug plan. Most Medicare Advantage plans include prescription drug coverage, but not every plan does.
- Through a stand-alone Medicare Part D prescription drug plan (PDP).
What are the differences between the ways you can get Medicare Part D coverage?
Let’s go through some of the features of each type of Medicare prescription drug plan, so you can match your needs and preferences to a type of plan.
|Medicare Advantage prescription drug plan||Stand-alone Medicare Part D prescription drug plan|
|Does it provide your Medicare Part A and Part B benefits?||Yes||No|
|Can it include extra benefits, like routine dental coverage?||Yes. Some Medicare Advantage plans (not all) offer certain additional benefits.||No|
|Can it cover your prescription drugs?*||Yes||Yes|
|Can it require you to use doctors in the plan’s provider network?||Yes (certain types of plans)||No|
|Can it offer discounts if you use the plan’s preferred pharmacies?||Yes (depends on the plan)||Yes (depends on the plan)|
|Requires you to be enrolled in Medicare Part A and Part B||Yes||Yes|
|Does it require you to live in the plan’s service area?||Yes||Yes|
|Can you also buy a Medicare Supplement insurance plan?||Medicare Supplement plans don’t work with Medicare Advantage plans.||Yes|
*Not every plan covers every medication. Even if a plan covers your medication, you may have to pay cost-sharing amounts such as deductibles, copayments, and/or coinsurance.
Please note that you need to continue paying your Medicare Part B monthly premium when you have a Medicare Advantage plan. That’s in addition to any premium your Medicare Advantage plan my charge.
How can you make sure a Medicare prescription drug plan covers your medications?
Once you’ve decided what type of plan you prefer to get your Medicare Part D prescription drug coverage, you can shop for plans. If you type your zip code into the box on this page, you’ll see a list of any plans available in your area. You can click on Medicare Advantage plans or Medicare Part D plans in the boxes on the page.
Then, click Add Your Rx Drugs. You can enter your prescriptions, and eHealth’s plan finder will help you narrow down your search to those Medicare prescription drug plans that may cover your medications.
Another way to make sure a plan may cover your medications is to check the plan’s formulary. That’s a list of drugs the plan covers. You might be able to see the formulary on the plan’s website, or you can call and ask.
Be aware, though, that Medicare prescription drug plans can change their formularies. Every fall, each plan sends out an Annual Notice of Change to every plan member. Any formulary changes will be noted there. Plans can change formularies at any time, not just the fall, but they notify you when necessary.
Both types of plan are available through private, Medicare-approved insurance companies. Premiums and other costs may vary from one plan to another.
Ready to start comparing Medicare prescription drug plans? Just enter your zip code on this page and you’ll see how easy and convenient it can be. Questions? eHealth’s licensed insurance agents will be happy to help if you reach out to us.