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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 Guide

Part 1: How Medicare Part D Works

Understanding the basics

Where can I get my prescriptions filled?

You must go to one of the pharmacies within your plan’s network, except in unusual circumstances. Going out of network will likely cost a lot more, maybe full price. Your plan must offer pharmacies within a reasonable distance from your home. Many plans also offer mail order services for 90-day supplies.

Some plans identify certain pharmacies in their networks as “preferred.” Filling prescriptions at the preferred pharmacies will likely mean that your copays will be lower than at other pharmacies in the plan’s network. But be careful to choose such a plan only if a preferred pharmacy is within a convenient distance of your home — otherwise your drugs may cost less in a different plan. 

Your plan must send you a list of its in-network pharmacies in your area when you first enroll. You can also find out which local pharmacies are in which plan networks, in advance of enrolling, by using the online Medicare Prescription Drug Plan finder tool.

How does the pharmacist know what to charge me?

You show your plan’s prescription drug card at the pharmacy (or send its number if you’re using mail order). The card should electronically access your information—whether or not you still have part of your deductible to pay, what coverage you’re entitled to, whether you have extra coverage that reduces the cost and what your copay should be.

Can I get a 90-day supply of my drugs?

Maybe. Some plans make 90-day supplies available through some retail pharmacies in their networks as well as through mail order. Contact your plan to find out.

Can I get my drugs both at a local pharmacy and by mail order under the same Part D plan?

Yes. As long as the plan offers both options (not all provide mail order), you can have your prescriptions filled from either source — for example, using mail order for 90-day supplies of drugs you take regularly, and the pharmacy for short-term meds such as antibiotics.

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