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Medicare Part D Coverage in Massachusetts


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Beneficiaries enrolled in Original Medicare or a Medicare Advantage plan can get prescription drug benefits through Medicare Part D. Medicare prescription drug coverage is available in two ways: You can either get it through a stand-alone Medicare Prescription Drug Plan or a Medicare Advantage Prescription Drug plan. Your coverage options will depend on whether you’re enrolled in Original Medicare or a Medicare Advantage plan, as well as the specific Medicare plan options available in your area.

Original Medicare, Part A and Part B offers limited prescription drug coverage, and you’ll need to enroll in a separate Medicare Prescription Drug Plan to get coverage for most types of prescription medications. These stand-alone plans are designed to work alongside your Medicare Part A and Part B coverage and are available through private insurance companies that are contracted with Medicare.

Alternatively, you can also get Medicare prescription drug benefits included as part of a Medicare Advantage plan (Medicare Part C). Also known as Medicare Advantage Prescription Drug plans, these plans offer all of your Medicare benefits (Part A, Part B, and Part D) all under a single plan. Medicare Advantage plans are available through private insurance companies approved by Medicare and are required to provide at least the same level of coverage as Original Medicare, Part A and Part B. However, some Medicare Advantage plans also cover benefits beyond Original Medicare, which may include hearing, routine vision or dental, and prescription drugs. Not every Medicare Advantage plan includes prescription drug coverage, so check with the individual plan you’re considering.

It’s important to note that if you have Medicare Part C and want prescription drug coverage, you should enroll in a Medicare Advantage Prescription Drug plan, not a stand-alone Medicare Prescription Drug Plan. In fact, if you’re enrolled in a Medicare Advantage plan that already includes prescription drug benefits and then subsequently enroll in a separate Medicare Prescription Drug Plan, you’ll be automatically disenrolled from the Medicare Advantage plan and returned to Original Medicare.

Enrolling in Medicare Part D coverage in Massachusetts

Medicare beneficiaries in Massachusetts, like the rest of the country, are eligible for Medicare Part D if they:

  • Have Medicare Part A and/or Part B and
  • Live in the service area of a Medicare plan that covers prescription drugs

There are specific times of the year beneficiaries may choose to enroll in Medicare Part D coverage in Massachusetts, including:

  • Initial Enrollment Period for Part D: This period occurs when a beneficiary first becomes eligible for Medicare benefits, either by turning 65 or through a disability. It typically coincides with your Initial Enrollment Period (IEP) for Part B, starting three months prior to the month you turn 65, including your birthday month, and ending three months later. For beneficiaries qualifying for Medicare because of a disability, their IEP for Part D starts three months prior to the 25th month of receiving Social Security or Railroad Retirement Board benefits, includes the 25th month, and ends three months afterward.
  • Annual Election Period: This period occurs every year from October 15 to December 7. Throughout the Annual Election Period (AEP), beneficiaries may enroll in or change their prescription drug coverage. This includes enrolling in a Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan for the first time, switching plans, or disenrolling from a Medicare plan.
  • Medicare Advantage Disenrollment Period: From January 1 to February 14, Medicare beneficiaries may choose to disenroll from their Medicare Advantage plan and return to Original Medicare. If you choose, you can also use this time to enroll in a stand-alone Medicare Prescription Drug Plan, but these are the only two types of changes you can make during this period.
  • Special Election Period: Beneficiaries with certain qualifying situations, such as a change in address, may make changes to their Medicare prescription drug coverage outside of the regular periods through a Special Election Period.

Choosing Medicare Part D coverage in Massachusetts

When finding Medicare Part D coverage, keep in mind that coverage, covered prescription medications, costs, and availability may all vary by location. If you’re considering enrollment in a particular Medicare Prescription Drug Plan or Medicare Advantage Prescription Drug plan, make sure to check that the formulary includes all of the medications you take. A formulary is a list of drugs covered by the plan. The formulary may change at any time. You will receive notice from your plan when necessary. This means that covered prescription drugs and cost-sharing can change annually.

Another factor to keep in mind is that Medicare plans typically place covered prescription drugs into cost tiers, with different copayments and coinsurance amounts for the medications on each tier. If the medications you take fall into the higher tiers, you could have higher out-of-pocket costs. Prescription drugs can be categorized into different cost tiers, depending on the plan. This means that taking the time to research and compare Medicare plan options may help you lower your out-of-pocket costs for your prescription medications.

Now that you have a better understanding of how Medicare Part D coverage in Massachusetts works, do you have any questions? For help finding Medicare plan options that may work for your situation, contact eHealth today to speak with a licensed insurance agent about your prescription drug needs.

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