How To Get Prescription Drug Coverage with Medicare Insurance

Updated: Feb 17

Most Americans need prescription drugs either on an as-needed basis or as a part of their regular health regimen. Seniors, in particular, rely on prescription drugs to stay healthy. Medicare drug coverage helps kupuna with the cost of the prescription drugs they need so they don’t have to pay 100% out of pocket. If you are getting ready to retire and switch to Medicare insurance, you should be considering your prescription drug coverage options. If you decide not to get it when you are first eligible and don’t have other creditable prescription drug coverage or Extra Help, you could end up paying a late enrollment penalty.


How to get prescription drug coverage with Medicare insurance


In order to get Medicare prescription drug coverage, you will need to become a member of a Medicare-approved plan that offers drug coverage either as part of the plan or through a compatible plan. All Medicare approved plans cover both Medicare Part A and Medicare Part B and they come in two forms: Original Medicare and Medicare Advantage (MA) plans / other Medicare health plans. Once you have signed up for your plan of choice, you can choose from available prescription drug plan options. There are many choices available and each one comes with its own cost and drug coverage benefits.


Contact a local Medicare agent for help deciding between Original Medicare and Medicare Advantage and the specific plan that suits your needs and budget. Your agent will also discuss your Medicare drug plan options and help you to enroll. After you have joined a Medicare drug plan you will call 1-800-Medicare to provide your Medicare Number and the date your Part A and/or Part B coverage started.


Learn about your drug coverage options


With so many options available, it’s important to identify the ones that could work for you. It’s also important to understand how different types of drug coverage interact with each other before making your decision. Seniors who have or are eligible for another form of prescription drug coverage such as coverage from the Department of Veterans Affairs (VA) or an employer will want to know how their coverage will work with and how it compares to Medicare drug coverage. In some cases, the drug coverage you have may change because of Medicare drug coverage. We highly recommend reading the materials provided from your insurer or plan provider. Your benefits administrator and a licensed Medicare agent should be useful resources to discuss the specifics with you.


Prescription drug coverage and Medicare Advantage Plans


Most Medicare Advantage plans include prescription drug coverage and cannot be paired with a separate Medicare drug plan. If you are enrolled in any of the following types of Medicare Advantage plans and join a separate drug plan you will be automatically disenrolled from your MA Plan and signed up for Original Medicare:

  • HMO Point-of-Service plan

  • Preferred Provider Organization

  • Health Maintenance Organization

There are other types of private Medicare plans that can’t or choose not to offer prescription drug coverage. For example, Medical Savings Account plans cannot offer drug coverage while certain Private Fee-for-Service and employer-sponsored Medicare health plans choose not to. If you decide to sign up for a Medicare plan that does not offer prescription drug coverage, you will have the option to join a free-standing Medicare drug plan.


Contact a PBC Agent for Help


Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.


At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.