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the medicare drug plan
6 Key Facts

1. Anyone on Medicare can get coverage regardless of income or health.

2. You are not obligated to enroll, but there may be consequences if you don't sign up when you are first eligible to do so.

3. To get Medicare drug coverage, you must select one approved private drug plan among many offering different choices. There is no single government plan.

4. Is your income limited? If you qualify for a part of the program known as "Extra Help." you'll pay very little for your medications.

5. Are your drug costs very high? You'll pay no more than 5 percent of the cost of each prescription after you've spent a certain amount of money out-of-pocket in any one year.

6. Do you have better drug coverage already? You probably won't need Medicare's Part D coverage. But it's wise to check.

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Medicare Prescription Drug Coverage Plan

Part 4: Do You Need Medicare Part D?

Considering all your options

What if I lose my current drug coverage or decide to drop it?

If your drug coverage is creditable and in the future you lose it through no fault of your own — for example, if your employer’s plan terminates or no longer meets Medicare’s creditability rules — you’d get a special enrollment period (SEP) to sign up for Part D without incurring a late penalty. But if you choose to drop your creditable coverage — for example, if it becomes too expensive to maintain — you won’t be entitled to an SEP, but must sign up during the open enrollment period that runs from Oct. 15 to Dec. 7 each year and begin Part D coverage on Jan. 1. If you go for more than 63 days without creditable coverage, you’d face a late penalty on joining Part D.

I’m a federal retiree. Do I need Medicare drug coverage?

No. If you’re enrolled in the Federal Employees Health Benefits Program (FEHBP) — as a current employee or retiree — your drug coverage is better than Medicare and you don’t need to sign up for Part D. But if there’s any advantage in having both types of coverage (for example, if your income is limited and you qualify for Part D’s low-cost Extra Help program), you can do so without risking your (or your dependents’) FEHBP benefits. (For more information, go to the website for the U.S. Office of Personnel Management, or call 1-888-767-6738 toll free.)

I’m a military retiree enrolled in the TriCare-for-Life program. Do I need Medicare drug coverage?

No. Drug coverage under the TFL program for military retirees and their dependents is much more generous than Medicare. But if your income is low enough to qualify for Extra Help, it’s worth comparing those benefits with what you have now. If there’s any advantage in enrolling in a Medicare drug plan, you can do so without risk of losing your (or your dependents’) TFL medical or drug coverage. If you should happen to lose TFL drug coverage in the future and switch to a Part D plan, you will not pay a late penalty as long as your Medicare drug coverage begins within 63 days of your current coverage ending. For more information on how TFL benefits fit in with Part D, call 1-800-538-9552 or go to the Tricare website.

I get my drugs from the VA. Can I sign up for a Medicare drug plan too?

Yes, if it would be an advantage. Veterans enrolled in the Department of Veterans Affairs health care program are allowed to be in the VA pharmacy program and a Medicare drug plan at the same time, without risk of losing VA medical or drug coverage. The same applies if you’re enrolled in CHAMPVA, the VA program for the dependents of some veterans killed or disabled in the line of duty. You can use either your VA benefit or your Part D plan coverage on a prescription-by-prescription basis, but you can’t use both for the same prescription. For example, you can use Part D benefits for drugs the VA doesn’t cover, and vice versa. If you lose VA drug coverage in the future and wish to enroll in a Part D drug plan at that point, you will not pay a late penalty as long as your Medicare drug coverage begins within 63 days of losing VA coverage.

For more information on how VA benefits fit in with Part D, call 877-222-8387 toll free or go to the VA website. For CHAMPVA information, go to the website for the VA Health Administration Center or call 800-733-8387.

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