Medicare Coverage for Prescription DrugsMedicare is a federally funded insurance program for individuals aged 65 and older or with certain disabilities and medical conditions. Medicare can cover many benefits, including inpatient care (Medicare Part A), outpatient services and physician-administered drugs (Part B) and medicines purchased at the pharmacy or via mail order (Part D). Medicare is provided through a federally administered model (known as Traditional Medicare) and a privately managed model (known at Part C, or Medicare Advantage).
What Is Medicare?
Medicare coverage is broken into four different parts. The different Medicare parts provide coverage for different types of health care services. When eligible individuals enroll in Medicare, they choose which Medicare parts they will participate in.
- Medicare Part A (Hospital Insurance) – Part A covers inpatient hospital stays, nursing facility care, hospice care and some home health care services.
- Medicare Part B (Medical Insurance) – Part B covers certain doctors’ services, outpatient care, medical supplies, physician administered medicines and some preventive services.
- Medicare Part C (Medicare Advantage Plans) – Part C is offered through private insurance companies. It provides all Part A and Part B benefits, and sometimes offers Coverage under a health plan of medicines that require a prescription (coverage may include restrictions on access to specific medications). See Step Therapy and Prior Authorization. prescription drug coverage too . In addition to the Medicare A and B benefits, Medicare Advantage plans may offer extra coverage for other services not covered under traditional Medicare.
- Medicare Part D (Prescription Drug Plan) – Part D offers prescription drug coverage through Medicare-approved private insurers.
You can learn more about Medicare coverage at www.medicare.gov.
Eligibility and Open Enrollment
You can only enroll in Medicare during certain pre-established times. Your initial enrollment period is determined based on when you become eligible for the program, which usually starts three months before the month you turn 65 and ends three months after the month you turn 65.
Regardless of when you enroll in Medicare, every year you can make changes to your coverage—including your Part D prescription drug coverage —during the Every year, health plans have a designated amount of time when consumers can make changes to their coverage for the following year. Employers set open enrollment periods for their employees, and the federal government or states set open enrollment periods for non-group health insurance coverage (such as individual market or Medicare coverage). Remember that the open enrollment period is the time to make changes to and reenroll in coverage. open enrollment period . Open enrollment happens every year from October 15 to December 7. You can find more insights on open enrollment in our article “3 Tips for Choosing a Medicare Part D Plan.” To help you find the Part D plan that works best for you, it’s a good idea to have your list of prescription medicines in hand as you review your options. The Medicare Plan Finder tool can make shopping for a plan easier too.
Medicare Extra Help
Medicare offers Extra Help to qualifying low-income beneficiaries who participate in Medicare Part D. This Extra Help gives eligible applicants additional assistance, such as help with premiums and out-of-pocket costs. You can learn more about what it covers and eligibility on the Medicare Extra Help with Prescription Drug Plan Costs website.
- Medicare Eligibility & The amount paid for health insurance coverage, usually paid monthly, quarterly or yearly. Premium payments vary based on the type of coverage and cost sharing a plan requires. Premiums do not count toward a deductible or toward the maximum out-of-pocket limit. Premium Calculator
- Medicare Plan Finder tool
- Medicare Health care items or services covered by health plans. Examples include emergency services, hospitalization, prescription drugs, laboratory services and wellness visits. benefits and online application
- Medicare Monday articles and insights on Medicare