Medicare prescription drug coverage is an optional benefit offered to everyone who has Medicare. However, if you decide to not get Medicare drug coverage when you’re first eligible, you’ll likely pay a late enrollment penalty if you join later.

The late enrollment penalty is an amount of money that will be added to your Medicare Part D monthly premium if you go for 63 days (or more) after your Initial Enrollment Period is over without one of these:

  • A Medicare Prescription Drug Plan (Part D)
  • A Medicare Advantage Plan (Part C) or another Medicare health plan that offers Medicare prescription drug coverage
  • Creditable prescription drug coverage

How do you get prescription drug coverage?

There are two ways:

  1. You can enroll into a Medicare Prescription Drug Plan (Part D) 
    • These plans, commonly referred to as “PDPs” will add drug coverage to your Original Medicare (Parts A and B). They can also work with some Medicare Cost Plans, Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. You can purchase a Medicare Advantage Plan (Part C)  
    • You must have Part A and Part B to join a Medicare Advantage Plan. You get all of your Medicare Part A (Hospital Insurance), Medicare Part B (Medical Insurance), and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.”

What prescriptions are covered?

The list of prescription drugs covered by the Medicare Part D plans (also referred to as a Plan’s Formulary) can vary plan to plan. To best understand, it’s best to speak with someone trained to help you based on your circumstances and where you live. You can do this by calling our Medicare Benefits Review Hotline at 855-515-5087.

In the meantime, it’s important to note Medicare Part D plans must cover all or substantially all drugs in six categories: antidepressants, antipsychotics, anticonvulsants, antiretrovirals (AIDS treatment), immunosuppressants, and anticancer.

Again, not every plan will cover each drug so it’s important to review and weigh your options to find a plan that fits your prescription drug needs and financial situation.

If you are looking for the best plan available in your area, click here to take our Medicare Benefits Finder Quiz. If you would prefer someone help you with this process, give us a call. This is a completely FREE service: 855-515-5087.