What If I have Medicare and No Prescription Drug Coverage?

Last Updated : 09/15/20185 min read

Do you have Medicare coverage, but no prescription drug coverage? You may be able to add prescription drug coverage through Medicare. This coverage is optional, but if you ever need it, it might save you money to sign up when you first get Medicare.

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Original Medicare and its limited prescription drugs coverage

Original Medicare, Part A (hospital insurance) and Part B (medical insurance), don’t cover most prescription drugs you would take at home. Part A may cover prescription drugs given to you when you’re a hospital inpatient, while Part B may cover certain prescription drugs administered to you in an outpatient setting such as a clinic.

What if I want Medicare prescription drug coverage?

If you’re enrolled in Medicare Part A and/or Part B, you can likely sign up for a Medicare Part D Prescription Drug Plan. There are two types of Medicare plans that provide Medicare Part D prescription drug coverage:

  • Stand-alone Medicare Part D Prescription Drug Plans, which work alongside your Medicare Part A and/or Medicare Part B coverage
  • Medicare Advantage Prescription Drug plans, which provide your Medicare Part A, Part B, and Part D benefits in a single plan. Medicare Part A (not your Medicare Advantage plan) still covers hospice benefits.

Both stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans are offered by private insurance companies contracted with Medicare.

How do Medicare Prescription Drug Plans work?

Each Medicare Prescription Drug Plan has a list of covered prescription drugs, called a formulary. The formulary may change at any time. You will receive notice from your plan when necessary. The prescription drugs on the formulary are grouped into different tiers (or categories). The higher tiers include the more expensive medications, while the lower tiers list the more affordable prescription drugs.

So, it’s important to note that not every Medicare Prescription Drug plan necessarily covers your medications. You might want to take a look at a plan’s formulary before you sign up, so you can make sure your medications are listed.

Each Medicare plan that includes Part D prescription drug coverage may charge a monthly premium. You might also be responsible for an annual deductible amount, and copayment or coinsurance. These costs vary among plans.

How do I enroll in a Medicare plan that provides prescription drug coverage?

The enrollment requirements are a little different for a stand-alone Medicare Part D Prescription Drug Plan than for a Medicare Advantage Prescription Drug plan.

  • Stand-alone Medicare Part D Prescription Drug Plans: you need to be enrolled in Part A and/or Part B.
  • Medicare Advantage Prescription Drug plans: you must have both Medicare Part A and Part B.
  • Both types require that live within the plan’s service area.

Usually, you can only enroll in a Medicare Prescription Drug Plan during certain time periods:

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  • During the seven-month Medicare Initial Enrollment Period, which typically begins three months before the month you turn 65, includes your birthday month, and ends three months after that month. If you qualify for Medicare due to disability, in most cases your Initial Enrollment Period is also a seven-month period (your 22nd through 28th month of receiving Social Security disability benefits).
  • During Medicare’s Annual Election Period, which runs from October 15 to December 7 each year
  • During a Special Election Period (SEP), if you qualify for one. For example, if you lose your creditable prescription drug coverage from another source, such an employment-based health plan, you might be eligible for a SEP.

What if I don’t want Medicare prescription drug coverage?

Medicare prescription drug coverage is optional – you don’t have to enroll. But there’s something you need to know. If you decide to skip this coverage for now, and then you later have a health condition that’s treated with prescription drugs, you might decide to enroll in a Medicare Prescription Drug Plan. But your prescription drug coverage may be more expensive if you delay it.

That’s because if you decide to sign up for Medicare prescription drug coverage after your Initial Enrollment Period is over, you might face a late-enrollment penalty that’s tacked on to your Medicare Prescription Drug Plan for as long as you have Medicare prescription drug coverage.

What if I already have prescription drug coverage?

You might have prescription drug coverage that’s not part of Medicare – for example, through an employer or union group health plan. If your prescription drug coverage is at least as good, on average, as standard Medicare Part D prescription drug coverage (that is, your coverage is considered “creditable”), you can generally keep it. You might want to make sure you don’t go without creditable prescription drug coverage for more than 63 days in a row to avoid paying a late-enrollment penalty if you later switch to a Medicare Prescription Drug Plan.

Are you thinking about adding a Medicare Part D Prescription Drug Plan to your Medicare coverage? I can help you evaluate the different plan options available to you and review your eligibility.

  • To get more information about your Medicare coverage options, feel free to use the links below; you can schedule a phone call with me or have me email information to you.
  • If you’d like to compare Medicare Prescription Drug Plans available where you live, use the Compare Plans or Find Plans buttons on this page.

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