Medicare And Prescription Drug Coverage


You won’t have prescription drug benefits included in original Medicare or any supplemental insurance plans that are currently sold. So if you are on Medicare and want to also be insured for prescription medication, you have the following options:

Medicare Part D Prescription Drug Plan (PDP)

Medicare Part D Plans are voluntary prescription drug insurance through Medicare, offered by private insurance companies and administered by Medicare. You may add such a plan, if other Medicare insurance you have, such as Medigap or a Medicare Advantage health plan, does not include coverage for drugs. These plans are available to any Medicare beneficiary who has Part A or Part B. If you have limited income, you may qualify for Extra Help.

Medicare Advantage Plan (MA-PD) With Prescription Drug Benefits

If you opt for a Medicare advantage HMO or PPO plan that includes prescription drug benefits, you basically replace your original Medicare, and your health care and prescription drug benefits will be provided by the MA-PD. The insurance company typically limits your benefits to a network of providers that you must use.
You are eligible for a MA-PD if you have Medicare Part A and Part B coverage, live in the plan’s service area, and don’t have End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant).

Other RX Insurance

You may also receive insurance for medication through other sources, such as a group health insurance through your (former) employer, your union, TRICARE, Indian Health Service, VA (Veterans Administration), or some other private insurance.

Discount Drug Plans

A discount drug plan is NOT insurance. The plan provider contracts with specific pharmacies and receives a commission whenever somebody uses the plan’s card. Discounts are based on the combined purchasing power of the amount of clients the plan has, and may vary, ranging anywhere from 0 to 75% compared to retail, depending on the plan, type of prescription, brand name, generic name or pharmacy. Usually, everybody qualifies and there is no waiting period.

While discount drug plans may help you save on prescription drugs, be aware of scams and carefully check the plan’s terms and conditions. You should stay away from a plan if it requires you to pay an annual membership fee or an enrollment charge, or only nets you a very small discount on the drugs you need, or the plan is not accepted at pharmacies you are using.

A discount drug plan might even be able to help you save money for medication that is not covered by your prescription drug plan.

No matter which alternative you select to help you pay for your prescription medication, it is very important that you are covered in case you have an unexpected illness that requires expensive medication on a regular basis. Having to pay for prescription drugs out of their own pocket turned out to be a devastating experience for many seniors on Medicare in the past.
By: Joseph Rosario

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