*How to get prescription drug coverage

Medicare prescription drug coverage is an optional benefit offered to everyone who has Medicare. This page explains how to get prescription drug coverage and offers tips for making the right choices for you.

If you decide not to get Medicare drug coverage when you’re first eligible, you’ll likely pay a late enrollment penalty if you join later, unless one of these applies:

  1. You have other creditable prescription drug coverage
  2. You get Extra Help

Generally, you’ll pay this penalty for as long as you have Medicare prescription drug coverage.

To get Medicare drug coverage, you must join a Medicare plan that offers prescription drug coverage. Each plan can vary in cost and drugs covered.

2 ways to get prescription drug coverage

  1. Medicare Prescription Drug Plan (Part D) . These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Find a Medicare drug plan.

6 tips for choosing Medicare drug coverage

If you’re wondering how to choose a Medicare drug plan that works for you, the best way is to start by looking at your priorities. See if any of these apply to you:

  1. I take specific drugs:
    1. Look at drug plans that include your prescription drugs on their formulary (a list of prescription drugs covered by a drug plan). Then, compare costs.
  2. I want extra protection from high prescription drug costs:
    1. Look at drug plans offering coverage in the coverage gap, and then check with those plans to make sure they cover your drugs in the gap.
  3. I want my drug expenses to be balanced throughout the year:
    1. Look at drug plans with no or a low deductible, or with additional coverage in the coverage gap
  4. I take a lot of generic prescriptions:
    1. Look at Medicare drug plans with “tiers” that charge you nothing or low copayments for generic prescriptions
  5. I don’t have many drug costs now, but I want coverage for peace of mind and to avoid future penalties.
    1. Look at Medicare drug plans with a low monthly premium for drug coverage. If you need prescription drugs in the future, all plans still must cover most drugs used by people with Medicare
  6. I like the extra benefits and lower costs available by getting my health care and prescription drug coverage from one plan, and I am willing to pick a drug plan with restrictions on what doctors, hospitals and other health care providers I can use.
    1. Look for a Medicare Advantage Plan (Part C) with prescription drug coverage.

How to join a drug plan

Once you choose a Medicare drug plan, here’s how to get prescription drug coverage:

  • Enroll on the Medicare Plan Finderor on the plan’s website.
  • Complete a paper enrollment form.
  • Call the plan.
  • Call us at 1-800-MEDICARE (1-800-633-4227).

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.

Consider all your drug coverage choices

Before you make a decision, learn how prescription drug coverage works with your other drug coverage. For example, you may have drug coverage from an employer or union, TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service, or a Medicare Supplement Insurance (Medigap) policy. Compare your current coverage to Medicare drug coverage. The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options.

If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.

Joining a Medicare drug plan may affect your Medicare Advantage Plan  

Your Medicare Advantage Plan (Part C) will disenroll you and you’ll go back to Original Medicare if both of these apply:

*Most or all information on this page is from web pages linked to and a part of website https://medicare.gov