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.
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 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)