How can I get prescription drug coverage?Question 1 of 2 (use "Last" or "Next" buttons to see more) Last Update: December 12, 2008
- Medicare Prescription Drug Benefit. If you are enrolled in Medicare Part A and/or Part B, or are eligible for Part A, you can get Medicare prescription drug coverage (Part D). Most people can only enroll during annual enrollment periods. Whether or not you should sign up for this benefit, depends on the quality of coverage you have now.
 For more information on whether you should take Medicare Part D coverage and how to get it, click on the links in the GO TO box.
- If you want to enroll, you must pick Medicare drug coverage that works with your Medicare health coverage.
- If you prefer to be in Original Medicare, choose a stand-alone prescription drug plan (PDP).
- If you prefer to be in a Medicare private health plan (a “Medicare Advantage” plan like an HMO or PPO), in most cases you must get Part D coverage as part of your health plan’s benefits package. Financial assistance is available for people with very low incomes.
For more information on how to choose between Original Medicare and a Medicare private health plan, click on the links in the GO TO box.
- Veterans Benefits. If you are a veteran, you may be able to receive prescription drugs prescribed by a Veterans Affairs (VA) doctor and filled at VA facilities. There is generally a small copayment for each 30-day supply. Copayments are waived for certain veterans. In addition, the VA now has a program under which some veterans can get prescription drugs from mail-order pharmacies instead of going to VA pharmacies. These veterans may also be able to get prescriptions from non-VA doctors filled this way.
For more information on Veterans Benefits and Medicare, click on the link in the GO TO box.
- State pharmaceutical assistance programs (SPAPs). Some states have pharmaceutical assistance programs that help save people money on their prescriptions. Many state programs coordinate with the Medicare drug benefit and require that you sign up for Part D to get state assistance (they help reduce your out-of-pocket Part D costs). Check out the MI Extra below to find out if your state has an SPAP, and how it works.
- Supplemental Coverage.
From an Employer. Your current or former employer may offer better prescription drug coverage than you can get elsewhere. Think carefully before giving up this coverage even if it is expensive. If you end coverage, you might not be able to get it back again.
For more information on employer or retiree insurance and Medicare, click on the links in the GO TO box.
Note: As of January 1, 2006, Medigaps (Medicare supplemental policies) are no longer sold with prescription drug coverage as part of their benefits packages. If you already have a Medigap H, I or J with drug coverage, you may keep the drug coverage—but it will not be considered as good as Medicare’s drug benefit (“creditable”). If you later enroll in a Part D plan you will be charged a penalty fee. Please consider other drug coverage options. If you purchased a “non-standardized” Medigap before 1992, and it has drug coverage, you should call the company that provides it and ask if the coverage is creditable. You do not automatically have the right to renew non-standardized Medigaps.
Massachusetts, Minnesota, and Wisconsin do not offer the 12 standardized Medigap plans A–L. Instead each state developed its own Medigap plans. You can no longer buy a Medigap with prescription drug coverage in any of these states. However, if you purchased a Medigap with prescription drug coverage before January 1, 2006, you can keep your Medigap with drug coverage. You should be aware that in Massachusetts and Wisconsin none of the Medigaps with prescription drug coverage are considered “creditable coverage” and you will be charged a penalty if you ever decide to enroll in Part D. However, in Minnesota, as of October 2008, the Extended Basic Plan is considered “creditable coverage” while the Basic Plan is not.
For more information on Medigaps, click on "What insurance can I buy to fill gaps in Original Medicare?" in the GO TO box.
If you need help paying for your prescriptions—even with prescription drug coverage—there are programs that can help. To find out more, click on the links in the GO TO box.
To learn more about programs in your area that could offer prescription drug coverage, contact your State Health Insurance Assistance Program (SHIP). Find your SHIP’s contact information by clicking on the link to its web site in the LINKS box.
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