How Can My Parents Get a Medicare Prescription Drug Plan?
Summary: Are you helping your parents with Medicare? Original Medicare, Part A and Part B, doesn’t cover prescription drugs except in limited cases. But you can help Mom or Dad sign up for a Medicare prescription drug plan. A couple of tips:
- They can choose to get this coverage through a stand-alone Medicare prescription drug plan, or a Medicare Advantage prescription drug plan.
- It’s usually best to get your parents to sign up for Medicare prescription drug coverage as soon as they’re eligible for Medicare. Otherwise, there might be a late enrollment penalty.
Do your parents suffer sticker shock over their bill at the pharmacy? They might benefit from Medicare prescription drug insurance. The good news is that Medicare prescription drug coverage, under Medicare Part D, is available to everyone with Medicare. It’s not free, but it may be worth it if your parents take prescription drugs.
To be eligible for a Medicare prescription drug plan, your parents must have either Medicare Part A, Part B, or both. Also, the plan they select has to be available where they live. Your parents don’t have to enroll in the same Medicare prescription drug plan. Remember, Medicare covers eligible individuals, not couples.
What types of Medicare prescription drug plans are there?
There are two types of Medicare prescription drug plans. Both are offered by private insurance companies that contract with Medicare. Your parents usually have two options.
- A stand-alone Medicare Part D prescription drug plan. These plans work alongside Original Medicare – Medicare Part A (hospital insurance) and/or Medicare Part B (medical insurance).
- A Medicare Advantage prescription drug plan. This type of plan combines medical and prescription drug benefits into a single plan. That is, your parent would get Medicare Part A, Part B, and Part D coverage through a Medicare Advantage plan. Note that not all Medicare Advantage plans cover prescription drugs, so make sure the plan your parent chooses has this coverage.
If they choose Medicare Advantage, your parents must have Medicare Part A and Part B.
When can your parents sign up for a Medicare prescription drug plan?
There are specific times when your parents can sign up for a Medicare prescription drug plan or change plans if they already have Medicare prescription drug coverage. Because your parents will probably qualify for Medicare on different dates, they can’t apply together. So let’s use Mom as an example.
- Medicare Initial Enrollment Period. The best time to enroll in a Medicare prescription drug plan may be when Mom is first eligible for Medicare. This is called the Initial Enrollment Period (IEP). If your Mom enrolls during this 7-month period, she’ll have the opportunity to sign up for a Medicare prescription drug plan. That way, she’ll have prescription drug coverage, starting the same time as her Medicare medical coverage. She’ll also avoid a potential late-enrollment penalty that could apply if she decided to get Part D coverage later.
- Medicare Annual Enrollment Period (October 15 – December 7 each year). Your Mom’s Medicare prescription drug coverage will begin on January 1 of the following year.
- Medicare Advantage Open Enrollment Period (January 1 – March 31 each year). Mom can switch Medicare Advantage plans during this time. For example, she may be able to:
- Switch from a plan that has no Medicare prescription drug coverage to one that does,
- Switch from a plan that has higher prescription drug costs to one that has lower costs, or
- Drop the Medicare Advantage plan and return to Original Medicare. Then, sign up for a stand-alone Medicare Part D prescription drug plan.
- Special Election Periods. When certain events happen in her life, such as moving or losing other insurance coverage, Mom might have the opportunity to change her Medicare coverage to fit her changed situation.
How Medicare prescription drug plans work
Medicare prescription drug plans share some common features that may help lower your parents’ prescription drug costs. Each plan might have:
- Copayments or coinsurance amounts. Plans may have an annual deductible.
- A network of retail pharmacies in the plan’s service area. Some plans have mail order options.
- A formulary, or list of medications covered by the plan. The formulary includes commonly prescribed brand-name medications and less expensive generic medications from all classes of prescription drugs.
- Different levels of the formulary called “benefit tiers.” The plan sorts covered prescription drugs into these tiers, generally based on drug costs.
That said, Medicare prescription drug plans are not all the same.
- Each plan has its own formulary of covered medications. So, while every Medicare prescription drug plan has a formulary, these lists vary among plans.
- Each plan sets its monthly premium (if any).
- Each plan sets its own cost-share for its benefits. The cost-share can include a deductible, copayment, and/or coinsurance for medications covered by the plan. Cost-sharing amounts are the member’s responsibility.
If the cost of Medicare prescription drug coverage is out of your parents’ reach, they may be eligible for Medicare’s Extra Help program. If your parents qualify for Extra Help, Medicare may be able to help them with prescription drug costs such as premiums, deductibles, and copayments.
Helping your parents choose a Medicare prescription drug plan
Help your parents make a list of their medications (a separate list for each parent). Your parents will want to do some comparison shopping and make sure the plans they choose cover their prescriptions.
Finding Medicare prescription drug plans where your parents live is simple. Your parents can start comparing plans by entering their zip code in the box on this page. They can enter their medications, and get an estimate of their total prescription drug costs.