Unscrewing the Cap: Understanding Medicare Part D Prescription Drug Coverage

Unscrewing the Cap: Understanding Medicare Part D Prescription Drug Coverage

If you’ve always had health insurance through your employer or spouse, you may be surprised to know Medicare plans don’t automatically come with prescription drug coverage.  That means you would have to pay for the medications you take to manage your high blood pressure, or to deal with a recent bout of acid reflux, out of your own pocket.  Plus, if you don’t enroll in a prescription drug plan when you are first eligible, there may be a penalty amount when you do enroll.

That’s why Medicare Part D plans are so important.  Medicare Part D plans provide comprehensive drug coverage and are available either on their own as standalone plans, or may be included in a Medicare Advantage plan. These federal prescription drug plans are available through private insurers like Blue Cross.

Here are a few more important things to know about Medicare Part D:

  • It’s available to anyone with Medicare. Medicare Part D is available to anyone eligible for or enrolled in Original Medicare (Part A and/or Part B) as of the date coverage would start.
  • You’ll need to add Part D to your Medigap plan. Medicare Supplement plans, also known as Medigap plans, fill in the gaps to cover some of the costs not covered by Original Medicare. It’s important to know that Medigap plans don’t include prescription drug coverage, though, so you will need to add a separate Medicare Part D plan.
  • Part D drug coverage is often included in Medicare Advantage plans. Nearly all Blue Cross Medicare Advantage plans come with prescription drug benefits. If you already have a Medicare Advantage plan that does not have prescription drug benefits, be careful not to enroll in a standalone drug plan; you might lose your medical coverage. Instead, choose a Medicare Advantage plan that has both medical and prescription drug benefits.
  • You may pay a lateenrollment penalty if you do not sign up for Part D when you are first eligible. If you don’t have prescription drug coverage as part of a Medicare Advantage plan, or you didn’t purchase a standalone plan to go with your Medicare Supplement plan or Original Medicare, a late enrollment penalty amount may be added to your Part D premium when you sign up. If you’ve been covered by your employer’s prescription drug benefits and that coverage is ending, ask them for a creditable coverage letter. This letter can help you avoid late-enrollment penalties.

Because prescription drug needs aren’t one-size-fits-all, Blue Cross has three Medicare Part D plans to choose from. Each has a different list of covered medications (also called a drug formulary). To find out more, click here. And to learn more about all of your Medicare options, check out these blogs:

Photo Credit: jarmoluk

Medicare Plus BlueSM,,  BCN AdvantageSM and Prescription BlueSM are PPO, HMO-POS, HMO and PDP plans with Medicare contracts. Enrollment in Medicare Plus Blue, BCN Advantage and Prescription Blue depends on contract renewal.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.  

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