Prescription Drug Coverage in Medicare — Part B and D | OpenMedicare
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Prescription Drug Coverage in Medicare — Part B and D

Published February 2, 2022

If you are eligible for Medicare, you are eligible to buy coverage for prescription drugs. With the cost of prescription drugs going up every year, and a penalty if you don’t enroll in the program when you turn 65, it makes sense to check out what is available to you in your area when you are first eligible for Medicare.

There are two ways prescription drugs are covered by Medicare. Some prescription drugs are covered by Part B of Medicare, while others are covered by the Part D program. Part B, which is generally your Medicare insurance for physician services and outpatient care, covers prescription drugs that are typically administered in a doctor’s office, oral cancer prescription drugs, or prescription drugs that require some type of equipment like a nebulizer or external infusion pump.

A Medicare Part D prescription drug plan is the standalone prescription drug plan that most people choose once they are eligible for Medicare. There is a late-enrollment penalty for each year you do not enroll in a Medicare Part D prescription drug plan after you become eligible for Medicare -- the three months before the birth month you turn 65, the month your birth month, and three months after your birth month. After that period, if you do not have prescription drug coverage through a "creditable" source, there will be a late-enrollment penalty every month you do not enroll.

Even if you don’t take any prescription drugs on a regular basis now or think you won’t in the future, it’s worth checking out one of the Medicare Part D prescription drug plans to find out what your costs might be.

Let’s take an example of a newly enrolled person in Medicare at age 65. Susan is generally healthy but she does have high blood pressure and takes a drug for that each month. If Susan lives in Omaha, Nebraska, she can go to the Medicare Part D site and insert her zip code of 68007, her County, the name of her prescription drug and its dosage, and she can see all the plans available in her area and the pharmacies that serve that plan. The Medicare website will even save the information you put in, in case you want to come back and add prescription drugs or change dosages later on.

Since you can change your Medicare Part D prescription drug plan every year, once you are enrolled, it makes sense to go online during the open enrollment period of October 15 to December 7 and see whether your plan still covers your specific drug and what the costs will be next year for that drug in that plan. Medicare makes it easy to change plans and there is no penalty for doing that. Starting in January 2021, Medicare is offering financial help with the costs of insulin. In the next Open Enrollment period, which starts October 15, 2023, you can check whether your Medicare Part D prescription drug plan offers help with the cost of insulin. And if you are eligible for “Extra Help” from Medicare, a program that helps low income seniors pay deductibles, coinsurance and Part D costs, your drug costs may be even lower or completely covered.

If you are enrolled in a Medicare Part C (Medicare Advantage), you probably already receive prescription drug coverage as part of your benefits. But not every Medicare Advantage plan offers drug coverage, so it is important to check that out when you first enroll in a Part C plan.

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