How do you get Medicare drug coverage?

There are two ways to get prescription drug coverage through the Medicare program. You can either enroll in a Medicare Advantage plan (Medicare Part C) that includes drug coverage, or you can enroll in a Medicare prescription drug plan (Medicare Part D).

Part C and Part D plans are provided by private health insurers and are regulated by the federal government.

Original Medicare (Parts A & B) does not provide prescription drug coverage.

Medicare Advantage plans (Part C)

All Medicare Advantage plans provide the same coverage as Original Medicare and some may include prescription drug coverage and other benefits.

88% of Medicare Advantage plans offered prescription drug coverage in 2017, according to the Kaiser Family Foundation (KFF).

Each Medicare Advantage plan has its own formulary, which is a list of drugs and brand names the plan will cover. Before enrolling in a particular Medicare Advantage plan, you should check its formulary to see if your particular medications are covered.

If you enroll in a Medicare Advantage plan that does not include prescription drug coverage, you may still be able to enroll in a Medicare Part D plan. However, some Medicare Advantage plans have rules which prohibit you from enrolling in a Part D plan. Check the details of a Part C plan before you enroll.

In 2017, 16.5 million people got drug coverage through Medicare Advantage drug plans, according to the KFF.

More info: Medicare Part C (Medicare Advantage plans)

Medicare prescription drug plans (Part D)

Medicare Part D plans provide prescription drug coverage for Medicare enrollees. Medicare Part D is optional coverage that works with many other types of plans, including Original Medicare and some Medicare Advantage plans.

In 2017, more than 42 million people were enrolled in stand-alone Medicare Part D plans, according to the KFF.

Part D plans have different formularies, tiers, coverage rules, and pharmacy networks. These factors may affect if and when your prescription drugs are covered.

Before enrolling in a Medicare prescription drug plan, you should confirm that the plan’s formulary covers your particular medications.

More info: Medicare Part D (prescription drug plans)