Two Ways to Get Drug Coverage

There are two ways in which you can receive Prescription drug coverage:

  1. One way is to enroll in a Medicare Prescription Drug Plan. These plans add drug coverage to Original Medicare, some Medicare Cost plans, some Medicare Private Fee-for-Service plans, and Medicare Medical Savings Account plans. You must have Part A or Part B to join a Medicare Prescription Drug plan.
  2. Another way is to enroll in a Medicare Advantage plan that includes drug coverage, like an HMO or PPO. Through these plans, you receive all of your Part A, Part B, and prescription drug coverage. Medicare Advantage plans that include drug coverage are called MAPD’s. To join a Medicare Advantage Plan, you must be enrolled in Part A and Part B of Medicare. Not all Medicare Advantage Plans include drug coverage. You can only add a stand-alone Prescription Drug plan to certain types of Medicare Advantage plans that don’t include drug coverage, such as a Private-fee-for-Service (PFFS) plan.

When can I enroll in a Prescription Drug Plan?

  • When you first become eligible for Medicare, you can join during your Initial Enrollment Period.
  • If you get Part B for the first time during the General Enrollment Period.
  • During Open Enrollment, between October 15th through December 7th.
  • Any time if you qualify for Extra Help.

What will I have to pay?

  • Monthly premium- if you have a higher income ($85,000 if you file individually, $170,000 if you’re married and file jointly), you will have to pay an extra amount in addition to your plan premium. Usually this will be deducted from your Social Security Check.
  • Yearly deductible- this is the amount you must pay before your drug plan begins to pay its share of your covered drugs. Some drug plans don’t have a deductible.
  • Copayments or coinsurance- these are the amounts you pay for your covered prescriptions after the deductible.
    Late Enrollment Penalty

You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable drug coverage. Learn more about this penalty here.