- 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.
- 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 Advantage Plan, 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.
- 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.
- 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 list of SPAPs to find out if you are eligible for assistance. For more information, contact your State Health Insurance Assistance Program (SHIP). You can find the number for your SHIP by visiting www.shiptacenter.org.
- 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.
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 creditable, meaning it is as good as Medicare’s drug benefit. 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.