RX Coverage

As a Medicare beneficiary, you have a few options when it comes to your Medicare Part D RX coverage (Prescription Drug Plan) and how to get it.

If you’re enrolled in Original Medicare, you can get prescription drug benefits through a stand-alone Medicare Prescription Drug Plan that works alongside your Medicare Part A and Part B coverage. If you have Medicare Part C, you can get prescription drug coverage through a Medicare Advantage Prescription Drug plan that covers your Part A, Part B, and Part D benefits. Both types of Medicare plans are available through private insurance companies that are approved by Medicare.

When comparing Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans, there are several factors to keep in mind while searching for a plan that fits your needs.

• Does the monthly premium provide a good value for your needs?
• Is the annual deductible amount something you are comfortable with?
• Does the plan cover all of your prescription drugs? What are the copayment and coinsurance costs for your prescription drugs?
• Do you want a stand-alone Medicare Prescription Drug Plan (PDP) that works alongside Original Medicare or a Medicare Advantage Prescription Drug Plan (MAPD) that includes all of your Medicare coverage under one plan?
• What are the initial coverage and out-of-pocket limits?
• Are you at risk for entering the Medicare Part D coverage gap (or “donut hole”), which is a temporary limit on what your Medicare plan will cover for prescription drugs? Read more about the coverage gap below.
• Does the Medicare plan include a pharmacy network? (Please note that pharmacy networks are subject to change; you’ll be notified by your Medicare plan if necessary.)