Medicare Part D offers the broadest prescription coverage based on meeting specific plan criteria. However, other parts of Medicare also offer different levels of drug coverage.
Medications are expensive, and according to a new Kaiser Family Foundation poll, 23% of older adults say they’re finding it hard to pay for their prescription medications. Affordable drug coverage is important for most Americans.
The good news is that thousands of Medicare plans can help offset prescription drug costs. Let’s take a closer look at Medicare’s different parts and the plan options available.
Medicare has four major parts that offer different benefits: hospital (Part A), outpatient medical (Part B), prescription drugs (Part D), and Medicare Advantage (Part C), which covers many of these options and a few other extras.
You can get prescription coverage under Medicare in the following ways:
- Part D: These plans are dedicated to covering FDA-approved prescription medications. Covered drugs are based on the specific plan you choose and the plan’s formulary or covered drug list. Your costs depend on your out-of-pocket costs, like deductibles and copays.
- Part A: This part of Original Medicare covers hospital stays, limited skilled nursing facility stays, hospice, and home healthcare when certain criteria are met. Medications you receive as part of your care are generally covered.
- Part B: This part of Original Medicare covers limited prescription medications that are usually given at a doctor’s office, dialysis center, or other outpatient hospital settings. The medications must be administered by a licensed healthcare professional.
- Medicare Advantage (Part C): These are private plans that must provide the benefits of Original Medicare, including Part A and Part B drugs, and some plans also offer Part D coverage.
Other optionsOther options to help with prescription drug costs include:
- Medigap: These plans don’t cover prescription drugs, but they can help you pay for the out-of-pocket costs like copays and deductibles of Parts A and B.
- Federally qualified health centers (FQHCs): These are federally funded health centers that can sometimes help lower your copays for prescription medications. You can ask if you’re eligible for copay help.
- Part D Low-Income Subsidy (LIS). Also called Extra Help, this program helps pay for premiums and lowers medication copays. If you qualify, you’d pay $4.50 for generic and $11.20 for brand medications in 2024. You might qualify for full or partial help. You still need to select a Part D plan and might be eligible to enroll during the special enrollment period if you qualify for Extra Help.
- Patient Assistance Programs (PAPs): These are offered directly through pharmaceutical companies. You may be eligible for discounts or pay nothing for your medication. Ask your doctor if you are eligible and about enrollment.
- State Pharmaceutical Assistance Programs (SPAPs): These programs help pay for prescriptions and other drug related costs. Check to see if your state has a plan and if you qualify.
You’re eligible for prescription drug benefits when you become eligible for Medicare. For most people, you become eligible 3 months before to 3 months after your 65th birthday.
If you’re getting Social Security benefits, you’re eligible for Medicare and will be automatically enrolled in Part A and B.
If you have ESRD, you may be eligible for Medicare before you turn 65. Also, if you’ve received Social Security disability payments for at least 2 years, you’re eligible 3 months before to 3 months after your 25th month of receiving benefits. You can also enroll in a Part D plan or Medicare Advantage plan.
You can also enroll for Part D coverage or change plans if your plan no longer provides coverage, you move to an area where your plan doesn’t offer coverage, you qualify for extra help, or other special circumstances apply.
To enroll in a Part D plan, you have several options. You can enroll:
- online through the Medicare plan finder tool
- by calling Medicare directly at 800-MEDICARE (800-633-4227)
- by contacting a private insurance company that offers the Part D plan you want or visiting the company’s website to submit an application
If you decide on a Medicare Advantage plan to provide your prescription drug coverage, you can shop for Part C plans with Medicare.gov’s plan finder tool, or you can enroll directly with the insurance company via its website or by phone.
When you enroll, be prepared to provide some basic information about yourself. You’ll also need to have your Medicare card ready to give your Medicare number and the date that your original Medicare coverage began.
Does Medicare Part D pay for all of your prescriptions?
Every Part D plan includes coverage for commonly used prescription drugs, including those treating serious diseases like cancer and HIV. These drugs are organized into tiers of varying costs. Typically, the lower-tier meds are more affordable than the higher ones. That said, each plan’s drug list or “formulary” may differ.
What is the best prescription coverage for seniors?
The best prescription coverage is going to vary for everyone. Even within Medicare Part D, each plan might cover different drugs, and your coverage depends on the plan and where you live. That said, you can look up your plan’s formulary, which is the list of covered drugs, to help you make the right choice.
Learn more: What is the best Medicare plan for seniors?
Prescription medications are covered in a few different ways with Medicare. There are thousands of Part D plans and Medicare Advantage plans to choose from, depending on where you live.
Parts A and B offer limited prescription coverage. Choose the best plan based on the medications you take and the out-of-pocket costs of the plan.