Medicare
Medicare is a federally funded insurance program for individuals aged 65 and older or with certain disabilities and medical conditions. Medicare can cover many benefits, including inpatient care (Medicare Part A), outpatient services and physician-administered drugs (Part B) and medicines purchased at the pharmacy or via mail order (Part D). Medicare is provided through a federally administered model (known as Traditional Medicare) and a privately managed model (known as Part C, or Medicare Advantage).
Medicare Coverage for Prescription Drugs
Medicare coverage is broken into four parts that each provide coverage for different types of health care services. When eligible individuals enroll in Medicare, they choose which Medicare parts they will participate in.
Medicare Part A (Hospital Insurance) – Part A covers inpatient hospital stays, nursing facility care, hospice care, and some home health care services.
Medicare Part B (Medical Insurance) – Part B covers certain doctors’ services, outpatient care, medical supplies, physician administered medicines, and some preventive services.
Medicare Part C (Medicare Advantage Plans) – Part C is offered through private insurance companies. It provides all Part A and Part B benefits, and sometimes offers prescription drug coverage too. In addition to the Medicare A and B benefits, Medicare Advantage plans may offer extra coverage for other services not covered under traditional Medicare.
Medicare Part D (Prescription Drug Plan) – Part D offers prescription drug coverage through Medicare-approved private insurers.
You can learn more about Medicare coverage at www.medicare.gov.
Eligibility and Open Enrollment
You can only enroll in Medicare during certain pre-established enrollment periods. Your initial enrollment period is determined based on when you become eligible for the program, which usually starts three months before the month you turn 65 and ends three months after the month you turn 65.
Regardless of when you enroll in Medicare, every year you can make changes to your coverage—including your Part D prescription drug coverage — during the open enrollment period. Open enrollment happens every year from October 15 to December 7. To help you find the Part D plan that works best for you, it’s a good idea to have your list of prescription medicines in hand as you review your options. The Medicare Plan Finder tool can make shopping for a plan easier too.
Medicare Extra Help
Medicare offers a low-income-subsidy known as “Extra Help” to qualifying low-income beneficiaries who participate in Medicare Part D. Extra Help gives eligible applicants additional assistance, such as help with premiums and out-of-pocket costs.
You can learn more about what it covers and eligibility on the Medicare Extra Help with Prescription Drug Plan Costs website.
Medicare Prescription Payment Plan
Medicare offers an option called the Medicare Prescription Payment Plan (MPPP or “smoothing”) for individuals enrolled in Medicare Part D. The MPPP allows beneficiaries to spread out their out-of-pocket prescription drug costs over the year, rather than paying all at once at the pharmacy. This can make it easier to budget for medicines and avoid unexpected expenses. Anyone with a Medicare Part D prescription drug plan can opt in to MPPP, regardless of income.
To learn more about MPPP and enroll, visit your Medicare plan’s website or call your plan directly.
