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En español | To get Medicare drug coverage you must join a private plan that is regulated by Medicare but run by an insurance company. The plan can be a “stand-alone” Part D drug plan — one that offers only drug coverage and is the type that can be used by people enrolled in the original Medicare program. Or it can be a Medicare Advantage plan (such as an HMO or PPO) that offers Part D drug coverage as well as medical coverage in its benefits package.
Within these two broad categories are many individual plans, each of which has different costs and benefits. Each plan has its own formulary — the list of drugs it covers — and sets the amount it charges for each drug. Therefore, it’s important to realize that (a) no plan covers all drugs; (b) different plans can charge widely varying copays even for the same drug; and (c) plans can change their costs (premiums, deductibles, copays) and formularies every calendar year.
If you’re enrolled in the original Medicare program, you have many stand-alone Part D plans to choose from — at least 18 in each state.
In the Medicare Advantage program, the number of plan choices varies according to where you live. Most of these plans include Part D prescription drug coverage. Note that if you enroll in an HMO or PPO that doesn’t offer drug coverage, you cannot join a stand-alone Part D plan to get drug coverage. But if you enroll in a much less common type of Medicare Advantage plan called a private fee-for-service (PFFS) plan, and it doesn’t offer drug benefits, you would be able to add prescription drug coverage by joining a stand-alone Part D plan.
For information on how Part D works, see AARP’s consumer guide to the program, at http://www.aarp.org/health/medicare-insurance/medicare_partD_guide/.
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