Information Below Supplied by Medicare.gov
Medicare offers prescription drug coverage to anybody that has Medicare insurance. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage, or you don’t get Extra Help, you’ll likely pay a late enrollment penalty.
To get Medicare prescription drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered.
Medicare Plan Finder
The Medicare Plan Finder is a web-based tool provided by Medicare that allows you to search for medicare plans in your area.
Frequently Asked Questions About Medicare Part D
How do you get Medicare Part D Prescription drug coverage? How do you get Medicare Part D prescription drug coverage? There are two ways to get Medicare prescription drug coverage:
When Can You Join a Medicare Drug Plan?
How Do You Join a Medicare Drug Plan?
What Does Medicare Part D Cover?
How Much Does Medicare Part D Cost?
What Are the Costs in the Part D "Coverage Gap?"
Original Medicare: Original Medicare is fee-for-service coverage under which the government pays your health care providers directly for your Part A
and/or Part B benefits).
Medicare Cost Plans: Medicare Cost Plans are a type of Medicare health plan available in some areas. In a Medicare Cost Plan, if you get services outside of the plan's network without a referral, your Medicare-covered services will be paid for
under Original Medicare; your Cost Plan pays for emergency services, or urgently needed services.
Medicare Private-Fee-for-Service Plans: Medicare Private Fee for Service Plans are a type of Medicare Advantage Plan (Part C) in which you can generally
go to any doctor or hospital you could go to if you had Original Medicare, if the doctor or hospital agrees to treat you. The plan determines how much
it will pay doctors and hospitals, and how much you must pay when you get care. A Private Fee-For-Service Plan is very different than
Original Medicare, and you must follow the plan rules carefully when you go for health care services. When you're in a Private Fee-For-Service Plan,
you may pay more or less for Medicare-covered benefits than in Original Medicare.
Medicare Medical Savings Account Plans: Medicare Medical Savings Accounts, also known as MSA Plans, combine a high deductible Medicare Advantage Plan
and a bank account. The plan deposits money from Medicare into the account. You can use the money in this account to pay for your health care costs,
but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount so
you generally will have to pay out-of-pocket before your coverage begins.
Both types of plans are called “Medicare drug plans.” In either case you must live in the service area of the Medicare
drug plan you want to join.
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Special Enrollment Periods: You generally must stay enrolled for the calendar year. However, in certain situations, you may be able to join,
switch, or drop Medicare drug plans at other times:
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How Do You Join a Medicare Drug Plan?
Once you choose a Medicare drug plan, you may be able to join by:
When you join a Medicare drug plan, you’ll give your Medicare number and the date your Part A and/or Part B coverage started. This information
is on your Medicare card.
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What Does Medicare Part D Cover?
Each plan has its own list of covered drugs (called a formulary; a formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. ). Many Medicare drug plans place drugs into different "tiers" on their formularies. Drugs in each tier have a different cost.
For example, a drug in a lower tier will generally cost you less than a drug in a higher tier. In some cases, if your drug is on a higher
tier and your prescriber (your doctor or other health care provider who is legally allowed to write prescriptions) thinks you need that
drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower copayment.
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How Much Does Medicare Part D Cost?
You’ll make these payments throughout the year in a Medicare drug plan:
Your actual drug plan costs will vary depending on:
You can look for specific Medicare drug plan costs using the
Medicare Plan Finder tool; then call the plans you’re interested in to get more details.
If you have limited income and resources, see if you qualify for Extra Help to pay for Medicare prescription drug coverage. You may also be able to
get help from the State of Massachusetts Medicare Page.
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What Are the Costs in the Part D "Coverage Gap?"
Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means there’s a temporary limit on what the drug plan
will cover for drugs.
Not everyone will enter the coverage gap. The coverage gap begins after you and your drug plan have spent a certain amount for covered drugs.
Once you enter the coverage gap, you get a 50% manufacturer-paid discount on covered brand-name drugs. Although you’ll only pay 50% of the price
for that brand-name drug, the entire price will count as out-of-pocket spending, which will help you get out of the coverage gap. You’ll also save 7% of
the plan’s cost for all generic drugs until you reach the end of the coverage gap.
Items That Count Towards the Coverage Gap include: your yearly deductible, coinsurance, and copayments; the discount you get on brand-name drugs in the
coverage gap; and what you pay in the coverage gap.
Items That DON’T Count Towards the Coverage Gap: the drug plan premium and what you pay for drugs that aren’t covered.
You can learn more about the Medicare Part D
Coverage Gap by clicking here.
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