Most people presume Medicare includes everything. It includes quite a bit, but not the cost of your typical prescriptions. This is why Part D is available as an option. Without adding to the confusion, Part C is an alternative to Original Medicare and may include some prescription drug coverage.
So, you’ll either have Parts A & B (Original Medicare) and opt in for Part D or you will have Part C (Medicare Advantage). In some cases, you may qualify to add Part D with Part C.
The short answer is, not the way you think it would. Medicare does not pay for prescription drugs you purchase at a pharmacy. As we age, this can become very expensive -- especially with heart disease and diabetes management. According to Heart.org “For the 60–79-year-old age group, the following have CVD: 69.1% of men; 67.9% of women.” So it’s reasonable to be prepared for these types of medicines. As always, talk to your doctor.
“Medicare Part B (Medical Insurance) covers a limited number of outpatient prescription drugs under limited conditions. Usually, drugs covered under Part B are drugs you wouldn't usually give to yourself, like those you get at a doctor's office or hospital outpatient setting.” Medicare.gov
Original Medicare (Parts A and B) do not cover typical prescription drugs. If you opt to enroll in Original Medicare, you need to also add a Part D plan (to avoid the enrollment penalty). Part D is insurance covering your prescription drugs.
Medicare Part D is your optional prescription drug coverage. Offered by private insurance companies, it is available to anyone enrolled in Original Medicare. The yearly deductible, according to Medicare.gov, must not exceed $435 in 2020.
Some Medicare Advantage Plans already have components that cover prescription drugs, but if yours doesn’t, you may be eligible for Medicare Part D as well.
Each Medicare drug plan will have its own list of covered drugs and whether or not they accept name brand or generic.. Medicare Part D also covers most prophylactic vaccines like the flu shot, insulin and diabetes supplies, and more. The cost of your prescriptions depends upon the plan you choose.
The best prescription drug plan for seniors depends upon the list of medications you take. Generally speaking, the lower the premium, the higher the copay. It’s best to make a list of all of your current medications (including the exact name) and use the Medicare Plan Finder. Or, contact an insurance broker who can help you with this.
Remember, that enrollment in Part D must happen during Open Enrollment, just as if you were under 65 years old and choosing medical insurance.
“Outside Open Enrollment (October 15 - December 7) you can enroll only during specific times, like your Initial Enrollment Period or a Special Enrollment Period.” Medicare Plan Finder
When you are choosing a plan, watch out for the terms “coinsurance” and “copay.” Copay is your portion of the cost, usually set in tiers. Coinsurance is generally a percentage of the cost. These terms aren’t mutually exclusive. You may have both, depending upon the drug.
Besides a list of drugs per each plan, every Part D plan has a coverage gap. You may hear people calling this the "donut hole". You wouldn’t want this to take you by surprise in October when your heart medicine is no longer $15 but $250.
“Once you and your plan have spent $4,020 on covered drugs in 2020, you're in the coverage gap. This amount may change each year.“ Medicare.gov
Choosing a prescription plan is not an easy task. This is why we have created an extensive Medicare Guide to help bring clarity.
Sign up with Healthy Access for our complete Medicare guide which covers this in more detail. Get the guide so you can get back to living your best life!