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I’ve recently retired and will be switching to Medicare soon. I’m worried because I’m a diabetic and on several other medications.
With work’s healthcare, my prescriptions were cheap, but with a fixed income, I’m concerned that I won’t be able to afford my medications. I’m wondering, does Medicare cover prescriptions?
Worried about my prescription costs,
Hana from Sarasota, Florida
Transitioning from an employer health plan to Medicare can seem intimidating and worrisome. We get it. And with pre-existing conditions like diabetes, knowing that you can get affordable prescription coverage is vital. I’ll do my best to answer your question and share some plan options.
First, Original Medicare does not cover prescription medications. Original Medicare means Medicare Part A and Part B. Part A and B cover preventative services, hospital stays, Durable Medical Equipment, and more. When you become Medicare-eligible, Medicare beneficiaries should enroll in Original Medicare.
Then, you must enroll in creditable prescription drug coverage or face late enrollment penalties. Because you are retiring, your creditable coverage will likely come from a Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage.
“You can get creditable prescription drug coverage from Medicare Part D or through a Medicare Advantage Prescription Drug plan.“
First, you must decide whether to enroll in Original Medicare alone or join a Medicare Supplement or Medicare Advantage plan. Most people choose to expand their coverage because Original Medicare does not cap out-of-pocket costs, which could place you in financial hardship.
There are advantages to choosing a Medicare Advantage plan for a person with diabetes. Many plans are specialized for people with diabetes and offer an Insulin Savings Program. When you select a Medicare Advantage plan that covers drugs, that’s called a Medicare Advantage Prescription Drug plan. Bonus, many Medicare Advantage plans offer a $0 monthly premium.
If you choose to enroll in Original Medicare alone or paired with a Medicare Supplement plan, you’ll likely need to enroll in a Medicare Part D plan. Medicare Part D plans cover prescription drugs. Your insulin would also be covered by Medicare Part D.
If you are low-income and need help affording your insulin and other prescription drugs, some programs can help. Extra Help can aid you in paying for the Part D premium, deductible, and prescription drug costs.
I hope this provided clarity and a way forward to getting the prescription medications you need at a price you can afford. If you’d like help deciding if a Part D or Medicare Advantage Prescription Drug plan is best for you, we can help. We can also assist you with applying for Extra Help if needed.
Call (623) 223-8884 to speak with a licensed Connie Health agent in your community. We’re here to provide the support you need throughout your Medicare journey.
While Part B doesn’t cover most prescription medications, it does cover certain medications administered in a clinical setting or during home health care. These include drugs used with an item of durable medical equipment (DME), injectable osteoporosis drugs, some antigens, Erythropoiesis-stimulating agents, blood clotting factors, injectable and infused drugs, and oral End-Stage Renal Disease (ESRD) drugs.
Medicare Part B does not cover most prescription medications you take home. If you require any other medications, you must enroll in Medicare Part D, a standalone prescription drug plan, or a Medicare Advantage plan with drug coverage.
Another option to obtain prescription drug coverage is through Medicare Advantage (Part C) plans, which work as an all-in-one alternative to Original Medicare. Many Medicare Advantage plans include prescription drug coverage with additional dental, vision, and hearing benefits.
Medicare Part D is the section of Medicare that covers prescription drugs. Part D is a standalone plan that private insurance companies offer. Each Part D plan has its own list of covered prescription drugs, known as a formulary. Researching different Part D plans and their formularies can help you choose the plan that best fits your prescription needs while minimizing the cost of your healthcare.
Medicare Advantage or Part C plans offer some prescription drug coverage and other healthcare benefits, like dental and vision care. Some Medicare Advantage plans, or MA-PD plans, combine medical and prescription drug coverage into one plan. Before enrolling in a Medicare Advantage plan, make sure the plan covers all the prescription drugs you need at an affordable price.
Read more by William Revuelta
I am a Spanish-speaking Florida Life and Health Insurance Licensed Agent and have been helping people with Medicare since 2009. I’m an avid sports fan and enjoy watching international soccer matches and college football. When not with my family, I listen to podcasts ranging from history to sports talk.