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Medicare Prescription Drug Coverage Basics:

Medicare prescription drug coverage is insurance.

Medicare prescription drug coverage (Part D) helps you pay for both the brand-name and generic drugs you need. It is coverage that adds to, or is included with, your Medicare health care coverage depending on the type of Medicare plan you join. You must choose and join a Medicare drug plan to get Medicare prescription drug coverage.

Everyone with Medicare has a decision to make about prescription drug coverage. If you don’t use a lot of prescription drugs now, you still should consider joining a Medicare drug plan. This coverage may help lower your prescription drug costs and help protect against higher costs in the future. If you are new to Medicare and have prescription drug coverage now, you have new choices to consider. If you aren’t new to Medicare, you have the opportunity to review your options for drug coverage and join or switch Medicare drug plans from November 15–December 31 each year.

Medicare drug plans are offered by insurance companies and other private companies approved by Medicare. There are 2 ways to get Medicare prescription drug coverage:

Medicare Prescription Drug Plans (sometimes called PDPs) add prescription drug coverage to the Original Medicare Plan, some Medicare Private Fee-for-Service (PFFS) Plans, some Medicare Cost Plans, and Medicare Medical Savings Account Plans.
Most Medicare Health Plans, including Medicare Advantage Plans (like an HMO or PPO), have prescription drug coverage. You generally get all of your Medicare health care and prescription drug coverage through these plans.

We use the term "Medicare drug plans" throughout this booklet to mean all plans that provide Medicare prescription drug coverage. To join a Medicare Prescription Drug Plan, you must have Medicare Part A (Hospital Insurance) and/or Part B (Medical Insurance). To join a Medicare Advantage Plan or other Medicare Health Plan with prescription drug coverage, you must have Medicare Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.

Medicare drug plans vary in what prescription drugs they cover, how much you have to pay, and which pharmacies you can use. All Medicare drug plans must provide at least a standard level of coverage set by Medicare. However, plans offer different combinations of coverage and cost sharing. Having a variety of plans to choose from gives you the chance to pick a plan that meets your unique needs. Choosing a plan that fits your situation allows you to get the coverage you want at the best price possible.

If you decide to join a Medicare drug plan, compare plans in your area and choose one that meets your needs. If you don’t join a Medicare drug plan when you are first eligible for Medicare, and you don’t have drug coverage that is, on average, expected to pay at least as much as standard Medicare prescription drug coverage (called creditable prescription drug coverage), you will have to pay a late enrollment penalty if you join later. You will pay the penalty in addition to your premium each month for as long as you have a Medicare drug plan.

(Primary Source: Centers for Medicare and Medicaid Services - Your Guide to Medicare Prescription Drug Coverage 2008. This content may have been added upon by Q1Group LLC to include further examples, explanations, and links.)

Last updated on: 11/14/2008

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