Prescription drug plans for seniors can be a complex and confusing topic. As we age, our healthcare needs change, and for many seniors, prescription drug costs can become a significant financial burden. That’s where Medicare prescription drug coverage comes in. 

Luckily, there are many options available to help seniors afford the medications they need. These plans offer coverage for prescription drugs and can help make necessary medications more affordable. However, with a variety of Part D plans available, as well as the inclusive coverage that Medicare Advantage provides, it can be hard to figure out which plan is right for you. In this article, we’ll take a closer look at Medicare-based prescription drug plans and help you understand your options.

How to Get Prescription Drug Coverage through Medicare

There are many options and variables that can impact your Medicare-based prescription drug coverage, so let’s start with the basics.

There are two distinct ways to get prescription drug coverage via Medicare: 

  1. Add a Medicare Part D plan: Also referred to as Original Medicare, Part A (hospitalization) and Part B (medical needs) are stand-alone and thus do not provide coverage for your prescription drugs. You can add Part D prescription drug coverage to your Part A and/or Part B plans during your initial enrollment (three months before and after you turn 65), during yearly open enrollment (October 15-December 7 each year), or during a Special Enrollment Period (SEP) — more on SEPs to come.
  2. Enroll in Medicare Advantage (MA): As an alternative to Original Medicare, Medicare Advantage bundles your Part A, Part B, and Part D coverage into one comprehensive plan. Offered by private companies but available through the Medicare website, MA can be incredibly helpful for seniors who need to manage multiple healthcare needs and want the convenience of having all of their coverage in one plan. We recommend Medicare Advantage plans for many different reasons, not least of which is  MA’s excellent selection of prescription drug plans for seniors.  It’s important to know that the Open Enrollment periods for Medicare Advantage and Original Medicare are not the same. Medicare Advantage’s Open Enrollment runs from January 1 – March 31 each year. However, you may also be eligible for Rest of Year (ROY) Enrollment through a Special Enrollment Period (SEP), which is explained later in this article. 

Most Medicare prescription drug plans (both Part D plans and Medicare Advantage plans with prescription coverage) have their own formulary, which is a list of covered drugs. It’s essential to choose a plan that covers the medications you need and has a reasonable monthly premium and deductible that fits your budget. It’s also important to keep in mind that not all medications are covered by your Medicare-based prescription drug plan, and in some cases, prior authorization may be required to receive coverage. 

It’s important to check your individual prescriptions and confirm whether they are covered by your chosen plan. You can use the Plan Finder tool provided by the Medicare website to find a plan that covers your medications. 

How to Get Prescription Drug Coverage During a Special Enrollment Period 

If you missed the Annual Enrollment Period for Medicare or Medicare Advantage, there may still be a chance to obtain prescription drug coverage. A Special Enrollment Period (SEP) is a period outside of the Annual Enrollment Period when you can make changes to your Medicare coverage. Generally, there are certain life events that trigger a Special Enrollment Period, such as moving to a new address or losing coverage from an employer.

There’s also an opportunity to change coverage if you are deemed eligible for a Special Needs Plan (SNP). There are three scenarios in which this can apply:

  • Chronic Condition SNP (C-SNPs): These are applicable for Medicare beneficiaries who have chronic health conditions, like cancer, diabetes or dementia.
  • Dual Eligible SNP (D-SNPs): An income-based consideration, these SNPs are for people who qualify for both Medicare and Medicaid. 
  • Institutional (I-SNPs): These SNPs come into effect if you require long-term specialized caretaking at home or in an institutional setting, such as a nursing home.

Because there is so much information to cover on these topics, we have a full blog post dedicated to answering questions about Special Enrollment Periods and Special Needs Plans, which you can read here

Our Staff Can Help with Prescription Drug Plans for Seniors

We hope that this blog has answered some of your questions about Medicare-based prescription drug coverage. Remember, our staff is always here to help answer any questions you may have and provide guidance to help ensure that your medical needs are fully met. 

At Meadowcrest Family Physicians, we’re committed to providing the highest level of customer service and support. Don’t hesitate to reach out to us by calling (352) 795-0644. We look forward to helping you stay healthy and happy!