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Should I get the same Medicare Part D Plan as my Spouse?

You may have had the same health care insurance as your spouse for decades, but that could change when you become eligible for Medicare. Medicare is individual health insurance, not family health insurance. This means that every person covered by Medicare must qualify on their own and have their own Medicare Part D plan. Spouses do not necessarily have to have the same Medicare Part D plan; however, they may opt to.

What is Medicare Part D?

Medicare Part D is optional coverage for prescription drugs. All Medicare Part D coverage is offered by private insurance companies regulated by Medicare. Everyone with Medicare is eligible for Medicare Part D, but you may have to pay an additional monthly premium to have Medicare Part D coverage. You also may have to pay a Medicare Part D deductible before your plan begins to pay for your prescription drugs. You and your spouse will have to pay separate Medicare Part D deductibles. The money your spouse spends on prescription drugs cannot count towards your deductible.

What are the coverage options for Medicare Part D?

There are two ways to get Medicare Part D:

  • A stand-alone Medicare Part D Prescription Drug Plan that goes along with Medicare Part A and Part B
  • A Medicare Advantage plan that includes Medicare Part A, Medicare Part B, and Medicare Part D prescription drug coverage

You and your spouse have at least four options:

  • You could both stick with Original Medicare (Part A and Part B) and get Medicare Part D through separate stand-alone plans.
  • You both could get all your Medicare coverage, including Medicare Part D coverage, through a separate Medicare Advantage plan.
  • One of you could get a stand-alone Medicare Part D plan to go alongside Original Medicare and one of you could get a Medicare Advantage plan with Part D coverage.
  • One or both of you could opt out of Medicare Part D coverage and pay for your prescription drugs out-of-pocket or through other insurance.

Why might my spouse want different Medicare Part D coverage than me?

There are many reasons your spouse may opt for different Medicare Part D coverage than you:

  • Your spouse may be older or younger than you and qualify for Medicare Part D at a different time. Different Medicare Part D plans may be available to him or her at the time she or he is eligible for Medicare.
  • Your spouse and you may have different health conditions. You may take more prescription medications than your spouse takes or he or she may take more prescription medications than you take.
  • Your spouse may prefer a Medicare Advantage plan and you may prefer to stay with Original Medicare and get a stand-alone prescription drug plan or vice versa.

What if I want to change my Medicare Part D plan to make it the same or different as my spouse?

If you want to change your Medicare Part D coverage, you may be able to do it during the Annual Medicare Open Enrollment Period (OEP) which is October 15 to December 7 each year.

During this period you can:

  • Join a Medicare Part D Prescription Drug Plan if you don’t have one yet
  • Switch from one stand-alone Medicare Part D plan to another one (to the same or different one as your spouse)
  • Switch from one Medicare Advantage plan to another one (to the same or different one as your spouse)

Individuals may also add or drop Part D coverage during the Medicare Advantage Open Enrollment Period (MA OEP) which is from January 1 to March 31 each year.

To find out more about Medicare Part D plans in your area, enter your zip code on this page.

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