Matt,
Do I need Medicare Part D for prescriptions, or is that covered with regular Medicare? If I need Part D, how can I sign up? Lastly, when should I refill my prescriptions for next year if I’m using the Medicare Part D plan?
Archie
Archie,
You will definitely need Medicare Part D as part of your coverage if you want to get prescription drug benefits. Part D can be included in Medicare Advantage plans or can be purchased individually and paired with Original Medicare parts A and B, with or without a Medicare Supplement or Medigap plan. Here is information on Medicare Part D, what it covers, and how you can get coverage.
PDP – Medicare Part D for Prescription Drug Coverage
A Medicare Part D Prescription Drug Plan (PDP) is the stand-alone prescription drug plan you add to your Medicare coverage if you don’t have a Medicare Advantage plan with Medicare Part D Prescription Drug benefits already embedded (MAPD) or get it through your employer’s retiree plan. These are also called Part D plans, referred to by the acronym PDP, or Medicare Part D Prescription Drug Plans.
While Medicare Part D helps pay for “retail” prescriptions at your local pharmacy or via mail-order, you can only get this plan:
- Embedded into certain Medicare Advantage plans (MAPD plans).
- Offered as a stand-alone prescription drug insurance policy, used in conjunction with Original Medicare A and B medical coverage and oftentimes alongside a Medicare Supplement plan. Also commonly referred to as a Medicare Part D Prescription Drug plan or a PDP.
While Medicare Part D covers prescriptions, this part of Medicare insurance does not cover medical procedures—it only covers prescription drugs.
How Can I Add Medicare Part D Coverage?
❶ stay on Original Medicare and only buy a Medicare Part D Prescription Drug Plan or,
❷ stay on Original Medicare and buy a Medicare Part D Prescription Drug Plan and a Medicare Supplement Plan or,
❸ buy a Medicare Advantage plan that includes Medicare Part D benefits
When Should I Get My Prescriptions Refilled with Medicare Part D?
As the calendar approaches January 1, you’ll want to get your prescriptions refilled ASAP as the coverage for your prescription drugs may be different for next year, so the prescription you’re using now may or may not be covered.
To avoid paying more out-of-pocket for your prescriptions, make sure to order them as soon as possible, as a process needs to happen before Medicare will approve and send out your prescription medications.
What is the Process that Medicare Uses for Prescription Drug Refills?
According to the Medicare website, medication safety checks must happen before the pharmacy fills your prescriptions. In addition, your insurance plan and pharmacy perform additional safety checks, such as
- Checking for drug interactions and incorrect dosages
- Checking for possible unsafe amounts of opioid pain medications (like oxycodone and hydrocodone)
- Limiting the day’s supply of the first prescription for opioids to an initial 7-day supply or less
- Limiting the use of opioids at the same time as benzodiazepines like Xanax®, Valium®, and Klonopin® (commonly used for anxiety and sleep)
I hope this helps!
Yours,
Matt Feret
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Author Bio Matt Feret is the author of the Prepare for Social Security -The Insider’s Guide and the Prepare for Medicare – The Insider’s Guide book series and launched PrepareforSocialSecurity.com to help people get objective answers to questions about Social Security and Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.
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