Medicare Prescription Drug Plans are stand-alone drug plans that add prescription drug coverage to Original Medicare. Prescription Drug Plans assist with the cost of prescription drugs, vaccines, and some medical supplies not covered by Medicare Part A and Part B. You can join a Prescription Drug Plan or switch plans during the Annual Enrollment Period which runs from October 15th- December 7th every year.
There are two ways to get medicare prescription drug coverage:
- Medicare Prescription Drug Plan (or Medicare Part D Plan). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
- Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug insurance coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug insurance coverage are sometimes called “MAPDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
What do Drug Plans Cover?
Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different “tiers” on their formularies. Drugs in each tier have a different cost.
A drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
How to fill a Prescription at the Pharmacy?
Provide your Medicare card, Prescription Drug Plan Card, and a Photo ID. If you are eligible for both Medicare & Medicaid, you will want to provide proof of your enrollment in Medicaid as well.
How to Fill Your Prescription without your New Plan card?
If you need to go to the pharmacy before your membership card arrives, you can use any of these as proof of membership:
- The acknowledgement, confirmation, or welcome letter you got from the plan.
- An enrollment confirmation number you got from the plan, and the plan name and phone number.
- A temporary card you may be able to print from MyMedicare.gov.
If you don’t have any of the items listed above, your pharmacist may be able to get your drug plan information if you provide your Medicare number or the last 4 digits of your Social Security Number.
If your pharmacist can’t get your drug plan information, you may have to pay out-of-pocket costs for your prescriptions. If you do, save your receipts and contact your plan to get your money back.