Does Medicare cover my prescriptions?

If you're on Medicare, you might assume your prescription drugs are covered. The short answer is: not automatically. And that's something a lot of people discover the hard way at the pharmacy counter.

Original Medicare doesn't cover prescriptions

When most people turn 65 and enroll in Medicare, they get Part A (hospital coverage) and Part B (doctor visits and outpatient care). But here's the catch: neither of those parts includes prescription drug coverage. If you want your medications covered, you need to add something else to your plan.

Your two main options

Part D plans are standalone prescription drug plans you can add to Original Medicare. You pay a monthly premium, and the plan covers a list of medications called a formulary.

Medicare Advantage plans (Part C) replace Original Medicare entirely and often bundle in prescription drug coverage. Some include it, some don't—so you need to check.

Both options come with their own formulary, which is basically the list of drugs the plan agrees to cover. This is crucial: just because a medication is on one plan's list doesn't mean it's on another's.

The formulary problem (and how to solve it)

This is where things get real. Your neighbor might rave about their Medicare Advantage plan because it covers their three medications perfectly. You could enroll in that exact same plan and discover none of your prescriptions are on it. Same plan, different outcome.

Before you enroll in any Medicare plan, you need to know whether your actual prescriptions will be covered. The formularies are out there, but comparing them yourself is tedious and error-prone. Most people don't do it—and then they're surprised.

At Summit Pointe Insurance Advisors in Lee's Summit, we handle this for you. We take your actual medications and run them against the formularies of the plans you're considering. We check which tier your drugs fall into (which affects your out-of-pocket costs), whether prior authorization is required, and whether there are any coverage gaps.

It's not glamorous work, but it's honest work that saves you money and hassle.

Timing matters

If you're new to Medicare, you have a window to choose a Part D plan or a Medicare Advantage plan with drug coverage. If you miss that window and go without coverage, you could face a permanent penalty when you do enroll. Don't let that happen.

If you're already on a plan but your prescriptions aren't covered well, the annual open enrollment period (October 15 to December 7) is your chance to switch to something better.

Next steps

Prescription coverage shouldn't be confusing or stressful. You need a clear picture of what your plan will actually pay for before you commit. That's where we come in.

Contact us at 816-282-2629 or visit https://summitpointeins.com to talk through your medications and find a plan that covers them.

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About Summit Pointe Insurance Advisors

Summit Pointe Insurance Advisors serves the Lee's Summit area and helps Medicare-eligible individuals and families understand their coverage options. We specialize in comparing plans based on your actual prescriptions and healthcare needs. Call us at 816-282-2629 or visit https://summitpointeins.com to get started.

Summit Pointe Insurance Advisors
816-282-2629
https://summitpointeins.com
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