What Medicare Part D drug plans cover

Overview of what Medicare drug plans cover. Learn about formularies, tiers of coverage, name brand and generic drug coverage. Official Medicare site.

 

Costs for Medicare drug coverage

Learn about the types of costs you’ll pay in a Medicare drug plan.

 

How Part D works with other insurance

Learn about how Medicare Part D (drug coverage) works with other coverage, like employer or union health coverage.

​

How to get prescription drug coverage

Medicare drug coverage helps pay for prescription drugs you need. It's optional and offered to everyone with Medicare. Even if you don’t take prescription drugs now, consider getting Medicare drug coverage. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered. 

​

There are 2 ways to get Medicare drug coverage:

1. Medicare drug plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee‑for‑Service plans, and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance)  and/or Medicare Part B (Medical Insurance)

to join a separate Medicare drug plan.

2.  Medicare Advantage Plan (Part C) or other Medicare Health Plan  with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage. To join a Medicare drug plan, Medicare Advantage Plan, or other Medicare health plan with drug coverage, you must be a United States citizen or lawfully present in the United States. 

​

Consider all your drug coverage choices

Before you make a decision, learn how prescription drug coverage works with your other drug coverage. For example, you may have drug coverage from an employer or union, TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service, or a Medicare Supplement Insurance (Medigap) policy. Compare your current coverage to Medicare drug coverage. The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options.

If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.

 

Joining a Medicare drug plan may affect your Medicare Advantage Plan  

If you join a Medicare Advantage Plan, you’ll usually get drug coverage through that plan. In certain types of plans that can’t offer drug coverage (like Medical Savings Account plans) or choose not to offer drug coverage (like certain Private Fee-for-Service plans), you can join a separate Medicare drug plan. If you’re in a Health Maintenance Organization, HMO Point-of-Service plan, or Preferred Provider Organization, and you join a separate drug plan, you’ll be disenrolled from your Medicare Advantage Plan and returned to Original Medicare. 

​

You can only join a separate Medicare drug plan without losing your current health coverage when you’re in a:

• Private Fee-for-Service Plan

• Medical Savings Account Plan

• Cost Plan

• Certain employer-sponsored Medicare health plans

​