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Frequently Asked Questions about Medicare Prescription Drug Coverage

By Ron Pollack Modified: February 28, 2013 at 1:27 pm •  Published: February 28, 2013

Since 2006, everyone with Medicare has had access to outpatient prescription drug coverage. Because there are a lot of options and choices to be made, the path to that coverage can be complicated. In an effort to lessen some of those complications, here are answers to some of the most commonly asked questions about Medicare prescription drug coverage.

Q. What are the different ways that Medicare offers prescription drug coverage?

A. Most people with Medicare get coverage through Medicare Part D. If you have Original Medicare (Parts A and B), you can add a Medicare Part D prescription drug plan for an additional premium. If you have a Medicare Advantage plan (sometimes called Medicare Part C), it probably includes Part D drug coverage, but you should check the plan to be sure. Some people have prescription drug coverage through a former employer. If this coverage is as good as or better than Part D coverage, you can keep it and you don’t need to sign up for Part D.

Q. When can I join or change drug plans?

A. When you first become eligible for Medicare (usually around your 65th birthday), you can sign up for a Part D plan or a Medicare Advantage plan when you enroll in the rest of Medicare. Be sure to sign up within three months of your 65th birthday to avoid a penalty. Then, each year between October 15 and December 7, Medicare has an open enrollment period during which you can change Part D plans or switch in to or out of a Medicare Advantage plan.

Q. What is a formulary?

A. A formulary is a list of medicines that your prescription drug plan covers. This list determines how much you will have to pay out of pocket for a prescription (your copayment). The amount varies depending on the category of drug: Generics are usually the cheapest, preferred brand-name drugs are more expensive, and non-preferred brand-name drugs are the most expensive. Some plans have four or more levels of copayments. Drugs that are not listed on the formulary are not covered at all. If drugs that you currently take aren’t on a plan’s formulary, or if they are very expensive, you should check out other plans.

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