While joining a Medicare drug plan is optional, understanding the importance and benefits of these plans are key to making your decision.
A common question we often receive at our call center is whether Medicare beneficiaries need to sign up for prescription drug coverage. The short answer is no. Joining a Medicare drug plan is optional and not a requirement. However, Medicare requires all beneficiaries to have creditable prescription drug coverage or face a late enrollment penalty. If you have Original Medicare coverage and would like coverage for your prescription drugs, you may want to consider signing up for a Medicare drug plan as Part A and Part B do not cover most medications.
How do I get drug coverage?
Prescription drug coverage is available to everyone with Medicare. You can join a drug plan when you are first eligible for Medicare. In most cases, if you don’t join during your Initial Enrollment Period, your next chance to join will be during the Annual Election Period (from October 15 through December 7 each year), and you will likely have to pay a late enrollment penalty. Prescription Drug Plans are offered by private insurance companies, and follow Medicare guidelines.
Each plan can vary in cost, the variety of covered medications, and how these drugs are covered. There are two main
ways to get drug coverage:
- Medicare Prescription Drug Plan. These plans are also known as “PDPs” and add drug coverage to Original Medicare, Part A and Part B, some. Some Medicare Cost plans, some Private Fee-for-Service (PFFS) plans, and Medical Savings Account (MSA) plans.
- Medicare Advantage (Part C ): Beyond Original Medicare benefits, these plans can offer prescription drug coverage and can come in a variety of different types, which includes, but is not limited to, Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) plans. Medicare Advantage plans that include drug coverage are also known as Medicare Advantage Prescription Drug (MA-PD) plans. You must be enrolled in both Part A and Part B to join a Medicare Advantage plan.
The cost of having no prescription drug coverage may turn out to be higher than paying for that coverage.
Additionally, beneficiaries are required to have creditable prescription drug coverage, which is medication coverage that is at least as good as Medicare’s standard prescription drug coverage. If you go a period of 63 days or more in a row without Part D coverage and do not have any other form of creditable drug coverage, you may be subject to a Part D late enrollment penalty .
Medicare hasn’t approved or endorsed this information.