Terms of Use 

Medicare offers insurance coverage for prescription drugs through Medicare prescriptions drug plans and other health plan options. Medicare prescription drug coverage is insurance provided by private companies that have been approved by Medicare.

The Medicare prescription drug coverage: : 

  • Helps you pay for the prescriptions you need.
  • Is available to all people with Medicare.
  • Pays for brand name as well as generic drugs.
  • Provides additional help for those who need it most.

Medicare prescription drug coverage helps you pay for the prescriptions you need.  Medicare's new prescription drug coverage typically pays over half of your drug costs for a monthly premium. It protects you once your out-of-pocket drug spending is more than $3600 in a year.

You can choose and join the Medicare drug plan that works for you. You will have to pay a monthly premium. All drug plans must provide coverage that is at least as good as standard Medicare prescription drug coverage. Some plans might offer more coverage and additional drugs for higher monthly premiums. If you decide not to join a Medicare drug plan when you are first eligible, you may have to pay a penalty if you decide to join later.  Note: If you already have prescription coverage from other insurance, you can keep that coverage. If that coverage offers the same or better benefits, you will not have to pay a higher premium if you decide to join later. Check with your other insurance to see how your coverage compares.

Medicare prescription drug coverage is available to all people with Medicare.  Joining is your choice.  To enroll, you must have Medicare Part A or Part B. Once enrolled you can change your plan during the open enrollment period, which is from November 15 through December 31 each year. Your Medicare prescription drug plan will begin January 1 of the following year.

To join, you will need to decide how you want to get your prescriptions. You can:

  • Get all your health care benefits and prescriptions through a Medicare Advantage Managed Care Plan that offers optional coverage for prescription drugs,
  • Get your health care benefits through the Original Medicare Plan and choose a Medicare prescription drug plan, or
  • Get your health care benefits through another type of Medicare Advantage health plan or a Medicare Managed Care Plan that isn't a Medicare Advantage Plan. In these kinds of plans, you may be able to choose a Medicare prescription drug plan.

Medicare prescription drug coverage pays for brand name as well as generic drugs.  Insurance companies and other private companies will work with Medicare to provide a choice of plans that cover both brand name and generic drugs. If the list of drugs covered by the plan does not include a drug you need, talk with your doctor's office.  See if there is another drug on your plan's preferred drug list that would work as well.  If there is, your doctor will write a prescription for that drug.  If there is not a suitable alternative, your doctor can write a "letter of exception" to that company requesting that it pay for the drug you need. 

There is additional help for those who need it most.  If you have limited income and resources, you may qualify for extra help that will cover between 85 and almost 100 percent of your drug costs. Most people who are eligible for this extra help will pay no premiums, no deductibles, and no more than $5 for each prescription. The amount of extra help depends on your income and resources.  If you qualify, you will need to join a plan to get drug coverage.

You can change your prescription drug plan.  If you are enrolled in Medicare's prescription drug program, you can change your plan each year between Nov. 15 and Dec. 31 or monthly if you’re eligible for both Medicare and Medicaid. Either way your new plan would begin on January 1 of the following year.

Your prescription drug plan's benefits may change.  The benefits offered by your plan may change each year in January but may never be less than the standard benefit.  The plan will tell you before open enrollment (Nov. 15-Dec. 31 of each year) about changes they intend to make at the end of the year. 

For more information about getting help with your prescription drug costs, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) or visit www.socialsecurity.gov.

To learn more about the Medicare prescription drug plan, call 1-800-MEDICARE (1-800-633-4227) or visit www.medicare.gov. You also will be able to get information on the drug plans available in your area.