Medicare Prescription Drug Plans (PDP)

Medicare drug coverage helps pay for prescription drugs you need. It’s optional and offered to everyone with Medicare. If you decide not to get it when you’re first eligible, and you don’t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later. Generally, you’ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered. 

For more detailed information about Prescription Drug Coverage please see this Guide.

Important Things to Know

  1. There are 2 ways to get Medicare drug coverage; either through enrollment in a Medicare Advantage plan that offers prescription coverage (MAPD), or through enrollment in an independent plan (PDP), which adds drug coverage to Original Medicare.
  2. If you choose a PDP, you can have the premium deducted monthly from your Social Security check.
  3. Each drug plan has its own formulary, so you should check to make sure your drugs are covered.
  4. Drug plans may require “prior authorization.” This means that before the drug plan will cover certain prescriptions, you must show the plan you meet certain criteria for you to have that particular drug. Your doctor may need to provide additional information about why the drug is medically necessary for you before you can fill the prescription. Plans may also require “step therapy” on certain drugs. This means you must try one or more similar, lower cost drugs before the plan will cover the prescribed drug. Plans may also set “quantity limits”—limits on how much medication you can get. Call your Medicare drug plan to find out the specific drug coverage rules for your plan.
  5. Check with each drug plan you’re considering to make sure your current pharmacy is in the plan’s network or there are pharmacies convenient to you. Some drug plans charge lower copayments or coinsurance amounts at some pharmacies in their network than at others. Also, some drug plans may offer a mail-order program that will allow you to have drugs sent directly to your home. You should consider the most cost effective and convenient way to have your prescriptions filled. Important: Even if you’re not changing plans, make sure your pharmacy is still in your plan’s network next year. Plans may change their network pharmacies each year.

Compare plans the easier way:

Medicare Prescription Drug plans vary by county and zip code. There may be several offered in your area. I’ll provide a report that includes price, financial ratings, and any pertinent information for the plans that interest you. I’ll help you check the formulary to ensure that the drugs you need are included.
And, of course, there’s

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  • No bias (I am totally independent)
  • No obligation (All decisions are yours)

*I am paid a commission by the insurance company if you choose to purchase a policy. This is at no cost to you.