Prescription drugs

Medicare Benefits Solutions
May 4, 2019

The high cost of prescription drugs can be a concern for anyone, but Medicare recipients generally spend more money on medications than others. Medicare Part A, Part B, and Medigap don’t include drug coverage, so it’s important to consider prescription drug coverage when you are first eligible for Medicare.

Some people who are relatively healthy and don’t rely on medications when they qualify for Medicare consider skipping drug coverage. But, consider this. If you develop an illness or chronic condition that requires regular medication, your out-of-pocket costs could be very high. Plus, if you don’t enroll for Part D when you are first eligible for Medicare, you’ll likely have to pay late enrollment fees when you sign up later.

Prescription Drug Plans (PDPs)

If you are getting your Part A and Part B benefits through Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). PDPs are sold by private insurance companies, so costs and coverage may vary. Each plan has its own formulary, or list of covered drugs, and can determine its own pricing. Pricing may vary based on whether you get generic or brand-name medications, if you use mail order prescriptions, and what pharmacy you use.

Medicare Advantage with prescription drug coverage (MA-PDs)

Medicare Advantage plans offer an alternative to Original Medicare. They are required to provide the same Part A and Part B benefits as Original Medicare, but many include Part D prescription drug coverage. As in the case of stand-alone drug plans, MA-PDs will have their own formularies and levels of pricing.

Comparing plans

Before you enroll in a Prescription Drug Plan or Medicare Advantage plan with prescription drug coverage, compare the formularies carefully. Make sure the plan you choose includes any current medication you take at the dosage you are prescribed.