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Medicare Part D and Original Medicare: An Overview

Medicare Part D and Original Medicare: An Overview

When you sign up for Original Medicare (Medicare Part A and Medicare Part B), you will also have an important decision to make about prescription drug coverage, also called Medicare Part D coverage. This article gives an overview and some highlights of Medicare Part D.

Medicare Prescription Drug Plans are sometimes called PDPs. They are offered by insurance companies and other private companies that have been approved by Medicare.

When you are first eligible for Medicare, you are also eligible to join a Prescription Drug Plan

  • If you do not join a Prescription Drug Plan when you are first eligible, you may have to pay a late enrollment penalty. Late enrollment penalties can impact your prescription drug costs for many years.
  • Some people can wait to join a Medicare Part D plan without incurring the late enrollment penalty. For example, if you have insurance with an employer or a union, and that insurance includes "creditable" drug coverage, you will not be penalized. The word "creditable" is a term used for insurance coverage that is the same as (or better) than Medicare Part D.

Medicare Pharmacies

Most Medicare Prescription Drug Plans have a network of pharmacies. It is common that PDPs require you to get your prescriptions from a pharmacy on the network list. If you do not, the plan may not pay.

  • Local retail pharmacies are on most network lists.  Using a network retail pharmacy with preferred cost sharing may cost less. For example, your co-payment for a drug may be lower.
  • Mail-order programs may be available. Some programs can send up to a 90-day supply of prescription medications to your home.
  • Some retail pharmacies may also offer the option to get 60-day or 90-day supplies of covered prescription drugs.

Each plan has its own list of covered drugs, called a formulary, and the cost of medications can vary. It is important to ask about the plan's list of drugs and the rules about covered medications. You should also learn about costs and how to get help to pay for medication if you have limited income and resources.

More options

You have other options as well, including replacing Original Medicare with a Medicare Advantage plan that not only provides medical coverage but also includes Prescription Drug coverage.

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