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Does Medicare Cover Prescriptions?

Christian Worstell

by Christian Worstell | Published December 16, 2020 | Reviewed by John Krahnert

If you have Original Medicare (Part A and Part B) and want prescription drug coverage, you can consider two options: enroll in a Medicare Part D prescription drug plan or a Medicare Advantage (Part C) plan that covers prescription drugs.

Learn more about each type of coverage how to find Medicare prescription drug coverage that works for you.

A pharmacist smiles and speaks to her patient about his medicationMedicare Part D plans and most Medicare Advantage plans cover prescription drugs.

Understanding Medicare Prescription Drug Coverage

Unlike Medicare Part A and Part B, which are administered by the federal government, Medicare Part D plans and Medicare Advantage plans are sold by private insurance companies.

  • Medicare Part D plans
    Part D plans are standalone prescription drug plans (PDPs) that can be used alongside your Original Medicare coverage. Your Part A and Part B benefits still apply, and your Part D plan can cover some of your prescription drug costs.

    You can have a Medicare Part D plan and a Medicare Supplement (Medigap) plan at the same time.

    You can compare Part D plans available where you live and enroll in a Medicare prescription drug plan online when you visit MyRxPlans.com.

  • Medicare Advantage plans
    Medicare Advantage (Part C) plans replace your Original Medicare coverage. A Medicare Advantage plan combines your Part A and Part B benefits into a single plan, and many Medicare Advantage plans may include additional benefits that Original Medicare doesn't cover.

    Many Medicare Part C plans cover prescription drugs. Some Medicare Advantage plans may also include coverage for things like vision and dental care, transportation to doctor's offices and home meal delivery.

The costs of your Medicare plan and the drugs it covers may vary depending on your plan. The Part D plans and Medicare Advantage plans available to you will also vary depending on where you live. 

Each Medicare plan that covers prescription drugs comes with its own formulary, or drug list. This list details which drugs the plan covers and what you may expect to pay for the drug.

Am I Eligible for Medicare Prescription Drug Coverage?

Anyone who is enrolled in Medicare Part A and/or Part B is typically eligible to enroll in a Medicare Part D plan or a Medicare Advantage plan (unless you have End-Stage Renal Disease, or ESRD).

It is important to enroll in either type of Medicare prescription drug coverage during your Initial Enrollment Period (IEP).

This is the 7-month period when you first become eligible for Medicare. It starts 3 months before your 65th birthday, includes your the month of your birthday and continues for another 3 months after that.

If you fail to sign up for Medicare prescription drug coverage during your IEP and decide to enroll in Part D coverage at a later date, you may have to pay a Part D late enrollment penalty unless one of of the following applies:

Can I Get Help Paying for Prescription Drug Costs?

Medicare Extra Help is available to beneficiaries who meet certain financial resource limits.

You may be automatically enrolled in Extra Help if you meet any of the following requirements:

  • You have full Medicaid coverage

  • You get Supplemental Security Income benefits

  • Medicaid helps pay your Medicare Part B premiums

If you need help paying for your prescription drugs but do not qualify for Extra Help, contact your State Medicaid Office to find out what other options you may have. You can also search for prescription drug assistance programs by state.

Medicare Supplement Plans Can Help Cover Other Medicare Costs

While Medicare Supplement Insurance plans don't cover prescription drugs, they can help pay for other Medicare out-of-pocket costs such as deductibles, copayments, coinsurance and more.

Learn more about common procedures that medicare covers.

Call today to speak with a licensed insurance agent who can help you compare the Medigap plans that are available where you live and find an option that fits your coverage needs.

 

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Christian Worstell is a health care and policy writer for MedicareSupplement.com. He has written hundreds of articles helping people better understand their Medicare coverage options.

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