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Do I Need a Medicare Prescription Drug Plan?



As you may already know, Original Medicare covers Part A, Hospital coverage and Part B, Outpatient medical coverage. However, Original Medicare does not include Drug coverage, which for most people is very essential. In order to obtain a prescription drug plan (Part D), Medicare members need to purchase this coverage through private insurance companies.

Who is eligible to purchase a Prescription drug coverage?

If you are eligible for Medicare coverage, you are also eligible for the Medicare drug benefit (Part D). You must be enrolled in Medicare Part A and/or Part B to enroll in Part D. You need to join a Part D drug plan during the 7-month initial enrollment period when you can sign up for Medicare Part A and Part B. This period runs from three months before the month of your 65th birthday to three months after it.


Medicare drug coverage is only available through private plans. If you have Medicare Part A and/or Part B and you do not have other drug coverage (creditable coverage), you should enroll in a Part D plan. This is true even if you do not currently take any prescription drugs. If you delay enrollment in Part D for any amount of time and find that you need drug coverage later, you will incur a premium late enrollment penalty.

How to obtain a prescription drug plan?

There are 2 ways to get drug coverage:

1. Enroll in a “stand-alone” Prescription Drug Plan. These plans (sometimes called "PDPs") add drug coverage to Original Medicare. Also,iIf you enroll in a Medicare Supplement plan you will likely want to add a “stand-alone” Prescription Drug Plan (Your Medigap plan does not cover prescription drugs).

2. Get your drug coverage from a Medicare Advantage Plan that offers 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

How much does it cost to purchase Part D coverage?

Your actual drug plan cost will vary depending on:

a) the drugs you use,

b) the plan you choose,

c) Whether you go to a pharmacy in your plan's network,

d) Whether the drugs you use are on your plan's formulary and

e) Whether you get Extra Help paying your Medicare Part D costs.


Each drug plan has a formulary specifically designed for that plan. The formulary is a list of drugs that are covered under each Part D plan and they are usually categorized by tiers. Tier 1 usually contains generic drugs whereas Tier 5 contains rare, specialty drugs. In general, you will have to pay a part D coverage premium set by the insurance company you will receive your coverage from, in addition to a yearly deductible and copayments/coinsurance for certain drug tiers.


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.


One thing you can certainly count on... prescription drug plans will change year after year. It is essential for you to meet with your trusted medicare insurance agent to revisit your current plan every year and make sure it still fits your needs and budget. We highly recommend choosing a local insurance agent that you can meet with face to face each year. Not only do the insurance plans change year after year, but your health insurance needs will also change over time. As Independent Brokers, we can take your list of prescriptions and use it to search for the lowest-cost plan available to you. Time spent with your local agent is time well spent. Contact us today at (540) 662-4432 to speak with Brian or one of our Insurance agents or visit our website medicaretrustedagents.com to obtain more information.

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