Medicare offers prescription drug coverage for everyone with Medicare. This coverage is called “Part D.” To get Medicare drug coverage, you must join a Medicare drug plan. There are two ways to get Medicare prescription drug coverage:
1. Join a Medicare Prescription Drug Plan. These plans (sometimes called “PDPs”) add coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
2. Join a Medicare Advantage Plan (like an HMO or PPO) or another Medicare health plan that includes prescription drug coverage. You get all of your Medicare coverage (Part A and Part B), including prescription drugs (Part D), through these plans. These plans are sometimes called “MA-PDs.”
Medicare drug plans are run by insurance companies and other private companies approved by Medicare. Each plan can vary in cost and drugs covered. If you decide not to join a Medicare drug plan when you are first eligible, you may pay a late-enrollment penalty if you choose to join later.
Medicare Advantage Plans include the following:
Medicare Preferred Provider Organization (PPO) Plans—You pay less for using plan network providers.
Medicare Health Maintenance Organization (HMO) Plans—You must use network providers for non-emergency care.
Medicare Private Fee-for-Service (PFFS) Plans—You can go to any provider who agrees to treat you.
Medicare Medical Savings Account (MSA) Plans—Money is placed in an account to use for health care before meeting the deductible in a high-deductible plan
Medicare Special Needs Plans (SNP)—They always include Part D coverage, and you can only enroll if you are a member of the “special needs” population that the plan serves
What do you need to know?- If you are in a Medicare Advantage Plan, you will usually get your Medicare prescription drug coverage from your plan. In most Medicare Advantage Plans, if you want drug coverage and your plan offers it, you must get it from your Medicare Advantage Plan.
- Only some Medicare PFFS Plans offer Medicare prescription drug coverage. If your Medicare PFFS Plan doesn’t offer Medicare prescription drug coverage, you can join a Medicare Prescription Drug Plan to add prescription drug coverage during a valid enrollment period.
- Medicare MSA Plans don’t offer Medicare prescription drug coverage. If you have a Medicare MSA Plan, you can join a Medicare Prescription Drug Plan to get this coverage.
- If you are in a Medicare Cost Plan, you can join a separate Medicare Prescription Drug Plan to add prescription drug coverage.
- If you are in a Medicare Cost Plan that includes Medicare prescription drug coverage, you can still join a separate Medicare Prescription Drug Plan. You will need to decide if you want to get your Medicare prescription drug coverage from the Medicare Cost Plan or from a separate Medicare Prescription Drug Plan.
