Prescription drug coverage for seniors changes at 65. Why? Because at 65, seniors are finally eligible for Medicare. It’s something they’ve paid into for decades while working. However, prescription drug coverage is not part of Original Medicare. Getting the prescription drug coverage you enjoyed while working will take a little more arranging.
What Is Prescription Drug Coverage?
Prescription drug coverage lowers the cost of prescriptions listed on a plan’s drug formulary. Rather than paying for the entire cost of a medication, seniors pay a small copay or coinsurance at the pharmacy.
Drug Coverage Before Medicare Eligibility
Before becoming eligible for Medicare, prescription drug coverage for seniors often comes through an employer group plan if they are still working. So, there is no need to find a separate plan to lower the cost of prescriptions.
If you are self-employed, or work for a small company that does not offer health insurance benefits, you most likely have an individual health insurance plan. All individual qualified health insurance plans must include prescription coverage as an essential benefit. So, you still would have no reason to search out other prescription drug insurance coverage.
Drug Coverage After Medicare Eligibility
As explained in our Guide to Medicare, Original Medicare (Parts A and B) covers inpatient hospital services, skilled nursing facility services, outpatient hospital services, and doctor visits. It does not include prescription drug coverage. In order to get your prescriptions covered, you need to enroll in a Medicare Part D or Medicare Advantage Plan.
Medicare Part D
Medicare Part D is a prescription drug coverage plan sold by private health insurance companies. It can be a standalone addition to Original Medicare, or it can be included in a Medicare Advantage plan. You will have to pay a monthly premium to have a Part D policy, and the plan will require you to pay other out-of-pocket costs like deductibles, copays, and coinsurance. A Medicare Savings program or “Extra Help” can lower those costs if you meet eligibility requirements.
Medicare Advantage (Part C)
Medicare Part C, often called Medicare Advantage, is also sold by private insurance companies. It includes Original Medicare (you do not lose Part A or B coverage) and usually includes other services like:
• Prescription Drug Coverage (Part D)
Choosing the Best Drug Insurance Plans
Whether an “all-in-one” Medicare Advantage plan or a standalone Part D plan suits you, HealthMarkets can help. Our licensed agents can review your options and find the best drug insurance plan for your unique needs. Just give us a call today at (800) 488-7621.