How Do I Pick the Drug Plan That’s Right for Me?

Medicare Benefits Solutions
Aug 24, 2020

If taking prescriptions is part of your daily routine and you’re a Medicare recipient or will be eligible to apply soon, it would be a good idea to strongly consider enrolling in prescription drug coverage. Medicare Part D covers a wide variety of prescription medications for all types of medical conditions, and in most cases, you’ll save a large amount of money on your prescription drug costs.

Your medical needs are unique. While Medicare offers prescription drug coverage through Part D that is meant to fit the needs of most people, only you can decide what’s right for your healthcare needs and budget. Review your current needs and any potential medications you may expect in the near future. Keep in mind that once you enroll, it’s likely that you won’t be able to change plans until the Annual Enrollment Period or a Special Enrollment Period.

Are the medications you need covered?

Each drug plan will have its own formulary, or list of covered drugs. If the drug you’re prescribed is not included in the formulary, then chances are that it will not be eligible for coverage. Try to find the plan that not only covers the drugs you currently take, but also the ones you may need in the future if your medical condition changes. Keep in mind that you may be able to file for an exemption if you are prescribed a drug and it is not included in your plan’s formulary, but these are evaluated on a case-by-case basis.

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Drug coverage is available through a stand-alone Prescription Drug Plan (PDP) if you have Original Medicare or through Medicare Advantage plans that include prescription drug coverage (MA-PD). Medicare Advantage plans are an alternative to Original Medicare, and are required to include the same Part A and Part B benefits, but most plans include additional coverage. An MA-PD may give you access to Parts A, B, and D along with other benefits, like vision and dental care, fitness programs, and more.

Does Part D cover outpatient and inpatient prescription medications?

Although Medicare’s Part D coverage does not cover drugs administered during inpatient or outpatient treatment, Medicare Part A and Part B are may cover those medications. Depending on your circumstances, you may be covered. For instance, if you need medication administered intravenously in an outpatient setting, you may be covered by Part B.  

Having prescription drug coverage in addition to Part A and Part B is beneficial because many people who receive medications while receiving inpatient or outpatient care will go on to require prescription medications after being released from care. In these situations, having Medicare Part D prescription drug coverage can end up saving you a lot of money when compared to paying full price for your medications without any type of insurance.

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