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4 Ways to Get Prescription Drug Coverage Under Medicare

By Lan Pham, Kaelyn Johnson, MPH, RD
Medicare prescription coverage depends on the plan in which you are enrolled.

The official U.S. government website for Medicare reports that there are generally two options for obtaining prescription drug coverage under Medicare: Medicare Part D or Medicare Advantage. However, certain Medigap policies or a Medicare Cost Plan can also help some individuals with their prescription drug costs. Read on for the key details about getting prescription drug coverage with Medicare. 

Medicare Part D

Enrolling in a Medicare Part D plan is one way you can get prescription drug coverage through Medicare. According to the official U.S. government website for Medicare, Part D plans are offered by insurance companies and other private companies that Medicare has approved. A Medicare Part D plan can help pay for both generic and name-brand prescription medication. 

Because each Part D plan will vary in its specific coverage, the official U.S. government website for Medicare lists some factors to keep in mind when selecting a Part D plan, such as:

  • Most Part D plans will cover drugs in certain protected classes, such as medications used to treat cancer or HIV/AIDS. 
  • Typically, Part D plans will issue a unique “formulary”, which is a list of covered medications. These formularies are often divided into tiers depending on their cost. Medications in the lower tiers will generally be less expensive than ones in a higher tier. 
  • If the specific medication you need is not listed on a plan’s formulary, a similar one may be. However, if you and your prescribing provider determine that none of the medications on your plan’s formulary are suitable for your treatment, you can request an exception. 
  • A Medicare Part D plan can change its formulary at any point during the year based on the development of new therapies, changes in drug therapies, or the release of new medical information—as long as it follows Medicare's guidelines for doing so

Medicare Advantage (Medicare Part C)

Medicare Advantage plans are another excellent option for getting prescription medication benefits with Medicare. Medicare Advantage is an alternative to Original Medicare (Parts A and B), and some Medicare Advantage plans combine Medicare Parts A, B, and D into one plan. 

To enroll in a Medicare Advantage plan, you must:

  • Have Medicare Part A and B
  • Live in the service area of the Medicare Advantage plan you want to join

It is essential to determine which drugs are covered and your estimated copay for your medication prior to enrolling in a new Medicare Advantage plan. Advantage plans are bound by law to provide the same coverage as Original Medicare. But the pharmacies you can go to for refills, the specific drugs they cover, and the out-of-pocket costs can vary from plan to plan. The official U.S. government website for Medicare offers a plan comparison tool so you can weigh all of your options.

Medicare Supplement (Medigap)

Certain individuals enrolled in Medigap supplemental insurance can get prescription coverage through it. Medigap is supplemental insurance that bridges coverage gaps for those enrolled in Original Medicare (Parts A and B). 

The Centers for Medicare & Medicaid Services notes that, before 2006, certain Medigap policies included prescription drug coverage. Individuals that enrolled in those plans do have the option of keeping their original Medigap prescription drug coverage. 

In addition, the official U.S. website for Medicare notes that those enrolled in pre-2006 Medigap plans with prescription drug benefits can also add a Medicare Part D plan to their coverage. In such a case, your Medigap insurer will remove prescription drug coverage from your plan and adjust your premium accordingly. However, once drug coverage is removed from your Medigap policy, you will not be able to get it back. 

Medicare Cost Plans

According to the official U.S. government website for Medicare, Medicare Cost Plans are a type of Medicare health insurance plan offered in limited regions of the country. These plans are very similar to Medicare Advantage plans, and some of them offer drug coverage.  

If you’re enrolled in a Medicare Cost Plan that includes drug coverage, you can still enroll in an additional Medicare Part D plan—but only at certain times of the year. While Medicare Cost Plans generally follow some of the same rules as Medicare Advantage Plans, you’ll need to contact the provider of the specific plan you’re interested in to get full details. 

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Interested in learning more about Medicare, Medigap, and Medicare Advantage plans? WebMD Connect to Care Advisors may be able to help.