Employer or union health coverage
Employer or union health coverage refers to health coverage from your, your spouse’s, or other family member’s current or former employer or union. If you have prescription drug coverage based on your current or previous employment, your employer or union will notify you annually about whether your prescription drug coverage is creditable. Keep the information you get from them for future reference.
Call your benefits administrator for more information before making any changes to your coverage.
If you join a Medicare Prescription Drug Plan, you, your spouse, or your dependents may lose your employer or union health coverage.
There may be reasons why you should take Medicare Part B instead of, or in addition to, COBRA. If you take COBRA and it includes creditable prescription drug coverage, you’ll have a special enrollment period to join a Medicare Prescription Drug Plan without a penalty when COBRA ends.
Talk with your State Health Insurance Assistance Program (SHIP) to see if COBRA is a good choice for you.
Medicare Supplement Insurance (Medigap) policy with prescription drug coverage
It may be to your advantage to join a Medicare Prescription Drug Plan because most Medigap drug coverage isn’t creditable. You may pay more if you join a drug plan later.
Medigap policies can no longer be sold with prescription drug coverage, but if you have drug coverage under a current Medigap policy, you can keep it. If you join a Medicare drug plan, your Medigap insurance company must remove the prescription drug coverage under your Medigap policy and adjust your premiums. Call your Medigap insurance company for more information.
Your drug costs are covered by Medicare. You’ll need to join a Medicare Prescription Drug Plan for Medicare to pay for your drugs.
In most cases, you’ll pay a small amount for your covered drugs. If you have full coverage from Medicaid and live in a nursing home, you pay nothing for covered prescription drugs.
If you have full coverage from Medicaid and live in an assisted living or adult living facility, or a residential home, you’ll pay a small copayment for each drug.
If you don’t join a drug plan, Medicare will enroll you in one to make sure you don’t miss a day of coverage. If you decide you want another plan, you can switch to another plan at any time.
Supplemental Security Income Benefits
If you get benefits or help from your state Medicaid program paying your Medicare premiums, you need to join a Medicare Prescription Drug Plan for Medicare to cover your drugs. You automatically qualify for Extra Help with your prescription drug costs. If you don’t join a plan, Medicare will enroll you in one to make sure you don’t miss a day of coverage.
State Pharmaceutical Assistance Program
Each state decides how its State Pharmaceutical Assistance Program (SPAP) works with Medicare prescription drug coverage. Some states give extra coverage when you join a Medicare Prescription Drug Plan. Some states have a separate state program that helps with prescriptions. Contact your SPAP to get more information.
Long-term care facility
Long-term care pharmacies contract with Medicare Prescription Drug Plans to provide drug coverage to their residents. If you’re entering, living in, or leaving a nursing home, you’ll have the opportunity to choose or switch your Medicare drug plan. This allows you to choose a plan that contracts with your nursing home’s pharmacy.
HUD housing assistance
If you get housing assistance from the Department of Housing and Urban Development (HUD), you may want to join a Medicare Prescription Drug Plan.
If you qualify for Extra Help, you won’t lose your housing assistance. However, your housing assistance may be reduced as your prescription drug spending decreases. The value of the Extra Help paying your drug costs will make up for any decrease in your housing assistance.
If you get food stamps, you may want to join a Medicare Prescription Drug Plan. If you qualify for Extra Help, your food stamp benefits may decline, but that decline will be offset by Extra Help.
If you’re near the food stamps eligibility cutoff, you may lose your minimum food stamp benefits because you’ll be paying less for your prescription drugs. The value of the Extra Help paying your drug costs will make up for any decrease in food stamp benefits.
Health Insurance Marketplace
While prescription drug coverage is an essential health benefit, prescription drug coverage in Marketplace or SHOP plans aren’t required to be at least as good as Part D coverage (creditable). However, all private insurers offering prescription drug coverage, including Marketplace and SHOP plans, must determine if their prescription drug coverage is creditable each year and let you know in writing.
The types of insurance listed below are all considered creditable prescription drug coverage. If you have one of these types of insurance, in most cases, it will be to your advantage to keep your current coverage.
Federal Employee Health Benefits (FEHB) Program
The Federal Employee Health Benefits (FEHB) Program plans usually include prescription drug coverage, so you don’t need to join a Medicare drug plan. However, if you decide to join a Medicare drug plan, you can keep your FEHB plan, and your plan will let you know who pays first.
For more information, contact the U.S. Office of Personnel Management (OPM). You can also call your plan if you have questions. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name.
You may be able to get prescription drug coverage through the Veterans Affairs (VA) program. You may join a Medicare Prescription Drug Plan, but if you do, you can’t use both types of coverage for the same prescription at the same time. For more information, contact the VA.
TRICARE (military health benefits)
Most people with TRICARE who are entitled to Medicare Part A must have Medicare Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you don’t need to join a Medicare Prescription Drug Plan.
For active-duty military enrolled in Medicare, TRICARE pays first. For inactive-duty military, your Medicare Prescription Drug Plan pays first.
If you join a Medicare Advantage Prescription Drug (MA-PD) Plan, the plan and TRICARE may coordinate their benefits if your MA plan network pharmacy is also a TRICARE network pharmacy. For more information, contact the TRICARE Pharmacy Program.
Indian Health Services
Many Indian health facilities participate in the Medicare prescription drug program. If you get prescription drugs through an Indian health facility, you’ll continue to get drugs at no cost to you, and your coverage won’t be interrupted.
Joining a Medicare Prescription Drug Plan may help your Indian health facility because the drug plan pays the Indian health facility for the cost of your prescriptions. Talk to your local Indian health benefits coordinator who can tell you how Medicare works with the Indian health care system.
If you’re getting care through an IHS or tribal health facility or program without being charged, you can continue to do so for some or all of your care. Getting Medicare doesn’t affect your ability to get services through the IHS and tribal health facilities.
Keep any creditable prescription drug coverage information you get from your plan. You may need it if you decide to join a Medicare drug plan later. Don’t send creditable coverage letters/certificates to Medicare.
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