Prescription plans for seniors who are Medicare eligible can change their coverage at age 65. Why? Because at 65, Medicare beneficiaries are finally eligible for Medicare. It’s something they or their spouse may have paid into for decades while working. However, prescription drug plans for Medicare beneficiaries are not part of Original Medicare. Getting the prescription drug coverage you enjoyed while working may take a little more arranging.

What Is Prescription Drug Coverage?

Prescription drug coverage lowers the cost of prescriptions listed on a plan’s drug formulary. Rather than paying for the entire cost of a medication, Medicare beneficiaries pay a small copay or coinsurance at the pharmacy.

Drug Coverage Before Medicare Eligibility

Before becoming eligible for Medicare, prescription plans often come through an employer group plan if you’re still working. There would be no need to find a separate plan to lower the cost of prescriptions.

If you’re self-employed, or work for a small company that doesn’t offer health insurance benefits, you most likely have an individual health insurance plan. All individual qualified health insurance plans must include prescription coverage as an essential benefit. So, you may have no reason to search out other prescription drug insurance coverage.

Drug Coverage After Medicare Eligibility

As explained in the HealthMarkets guide to Medicare, Original Medicare (Parts A and B) covers inpatient hospital services, skilled nursing facility services, outpatient hospital services, and doctor visits. It does not include prescription drug coverage. In order to get your prescriptions covered, you need to enroll in Medicare Part D or a Medicare Advantage Plan.

Medicare Part D

Medicare Part D is a prescription drug plan for Medicare beneficiaries sold by private health insurance companies. It can be a standalone addition to Original Medicare, or it can be included in a Medicare Advantage plan. You will have to pay a monthly premium to have a Part D policy, and the plan will require you to pay other out-of-pocket costs like deductibles, copays, and coinsurance. A Medicare Savings program or “Extra Help">Extra Help” can lower those costs if you meet eligibility requirements.

Medicare Advantage (Part C)

Medicare Part C, often called Medicare Advantage, is also sold by private insurance companies. It includes Original Medicare (you do not lose Part A or B coverage) and usually includes other services like:
• Vision
• Dental
• Prescription Drug Coverage (Part D)