Obamacare News Blog

Medicare Part D (Medicare Prescription Drug Coverage)

Medicare prescription drug coverage is insurance run by an insurance company or other private company approved by Medicare. There are two ways to get Medicare prescription drug coverage:

1. Medicare Prescription Drug Plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, and Medical Savings Account (MSA) Plans.
2. Medicare Advantage Plans are other Medicare health plans that offer Medicare prescription drug coverage. They include full Part A and Part B coverage, as well as prescription drug coverage (Part D).
If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other credible prescription drug coverage, you will likely pay a late enrollment penalty.

How Much Does Medicare Prescription Drug Coverage Cost?

Each plan can vary in cost and drugs covered. Our Quoting Tool can help you find and compare plans in your area.

Your Part D monthly premium could be higher based on your income. This includes Part D coverage that you receive from a Medicare Prescription Drug Plan, a Medicare Advantage Plan or Medicare Cost Plan that includes Medicare prescription drug coverage. If your modified adjusted gross income as reported on your IRS tax return from 2 years ago (the most recent tax return information provided to Social Security by the IRS) is above a certain amount, you will pay a higher monthly premium.

Many people qualify to get assistance in paying for their Medicare prescription drug costs, but don’t know it. Most who qualify and join a Medicare drug plan will get 95% of their costs covered. For those who need additional help, there are Medicare Savings Programs available to aid in making health care and prescription drug costs more affordable.

How Do I Get Medicare Prescription Drug Coverage?

To join a Medicare Prescription Drug Plan, you must have Medicare Part A or Part B. To join a Medicare Advantage Plan, you must have Part A and Part B. You must also live in the service area of the Medicare drug plan you want to join.

Remember, costs and coverage varies with each plan. Using our Quoting Tool can help you find and compare plans in your area. See the Senior65 Medicare Part D page for a complete overview on Medicare prescription plans.
 
How Does My Other Insurance Work with Medicare Drug Coverage?

If you have other insurance, find it below to understand how it works with, or is affected by, Medicare prescription drug coverage.

Employer or Union Health Coverage
This is health coverage based on the current or former employment of you, your spouse, or other members of your family. If you have prescription drug coverage based on employment, the employer or union will notify you each year to let you know if your drug coverage is creditable. It is important to keep the information that you receive.

If you join a Medicare drug plan, you, your spouse, or your dependants may lose your employer or union health coverage. Call your benefits administrator for more information before making any changes to your coverage.

COBRA
This is a Federal law that may allow you to temporarily keep employer or union health coverage after employment ends, or after you lose coverage as a dependent of a covered employee.

There may be reasons why you should take Part B instead of COBRA. However, if you take COBRA and it includes creditable prescription drug coverage, you will have a special enrollment period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends.

Medigap (Medicare Supplement Insurance) Policy with Prescription Drug Coverage
Medigap policies are no longer sold with prescription drug coverage. If you currently have drug coverage under a Medigap policy, you may keep it. However, you may opt to join a Medicare drug plan instead, because most Medigap drug coverage isn’t creditable.

If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.

The types of insurance listed below are all considered creditable prescription drug coverage. If you have one of these types of insurance, in most cases, it will be to your advantage to keep your current coverage.

Federal Employee Health Benefits Program (FEHBP)
If you join a Medicare drug plan, you can keep your FEHBP plan, and your plan will let you know who pays first. For more information, contact the Office of Personnel Management at 1-888-767-6738, or visit the Office of Personnel Management website. TTY users should call 1-800-878-5707. You can also call your plan if you have questions.

Veterans Benefits
You may be able to get prescription drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same prescription. For more information, call the VA at 1-800-827-1000, or visit the VA website. TTY users should call 1-800-829-4833.

TRICARE (Military Health Benefits)
Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you aren’t required to join a Medicare drug plan. If you do, your Medicare drug plan pays first, and TRICARE pays second. If you join a Medicare Advantage Plan with prescription drug coverage, TRICARE won’t pay for your prescription drugs. For more information, call the TRICARE pharmacy contractor at 1 877 363 8779, or visit the Tricare website. TTY users should call 1-877-540-6261.

Indian Health Services
If you get prescription drugs through an Indian health pharmacy, you pay nothing and your coverage won’t be interrupted. Joining a Medicare drug plan may help your Indian health provider with costs, because the drug plan pays part of the cost of your prescriptions. Talk to your benefits coordinator - they can help you choose a plan that meets your needs and explain how Medicare works with your health care system.