Prescription Drug Coverage: What to Expect With Medicare

Some older adults assume that they will automatically be covered for prescription drugs with Medicare. Unfortunately, this is not the case. Original Medicare only covers the costs of drugs associated with inpatient care (Part A) and certain outpatient care (Part B). For comprehensive prescription drug coverage, you will either need to add a Part D plan or switch to a Medicare Advantage plan that includes Part D coverage.

Now that you know how to get prescription drug coverage with Medicare, you may have some questions. More specifically, you probably want to know about enrollment, costs, and additional benefits. In this guide, we will answer all of the most important questions related to Medicare prescription drug coverage.

What Drugs are Covered by Medicare Part D?

Different Part D plans can cover different drugs. That said, all Medicare Part D plans must cover one or more drugs in every therapeutic category. Additionally, Part D must cover all (or the vast majority) of drugs within the following six categories:

What Drugs are NOT Covered by Part D?

Again, the specific drugs covered by Part D will vary by plan. That said, there are many drug groups that are typically not covered. Here are a few of the most common drug groups that Part D does NOT cover:

How Can I Enroll in Part D?

Since Part D is only provided through private insurers, you will need to contact one of Time for 65’s licensed insurance brokers for more information. Once you enroll through a private provider, the plan will work in tandem with your Original Medicare. However, you will have to pay Part D premiums, as Part D is treated as a separate plan.

How much does Part D Cost?

The monthly premium for Medicare Part D varies based on your location, your income, and the plan you choose. On average, enrollees can expect to pay around $30 per month for Part D coverage. For more information on Part D plans and premiums, consult one of our licensed insurance brokers.

Part D vs. Medicare Advantage

As previously stated, you can either get a standalone Part D plan to go with your Original Medicare, or you can get a Medicare Advantage plan. Medicare Advantage is a private insurance plan that covers the same expenses as Medicare Part A, Part B, Part D, and a few extras like vision, dental, and hearing.

Generally, you can save money on premiums by getting a Medicare Advantage plan. That said, you will need to consider how much you’re paying for both Part B and Part D every month to see which option works best for you. Additionally, Medicare Advantage offers additional coverage that Original Medicare and Part D do not cover.

The Bottom Line on Medicare Prescription Drug Coverage

Fortunately, older adults have options when it comes to prescription drug coverage. You can get a standalone Medicare Part D plan or you can get all of your Medicare benefits (including prescription drug coverage) through a Medicare Advantage plan. These choices allow you to customize your health insurance to fit your specific needs and budget.

Weighing the pros and cons of different prescription drug coverage plans can be difficult. If you are unsure about your options for prescription drug coverage through Medicare or have more questions about benefits, feel free to or to speak with our licensed insurance brokers today.