7 Steps to Medicare Eligibility: Step 5

Step 5: Picking a Medicare plan

What types of Medicare plans will cover drugs?
If you want Medicare Prescription Drug Coverage, you will need to choose the type of Medicare plan you would like. There are two types to choose from:

1) Medicare Prescription Drug Plans, or PDPs
2) Medicare Prescription Drug Plans are separate, free-standing insurance plans that will cover prescription drugs only.

You would pick a Medicare Prescription Drug Plan if you have either:
- Original Medicare (Medicare Part A or B)
- A Medicare Cost Plan or one of the Private Fee-For-Service (PFFS) Plans that does not include drug coverage.
- Medicare Advantage plans with Prescription Drug coverage, or MA-PDs
- Medicare Advantage plans are health plans that cover both your medical care and prescription drugs.

The major types of Medicare Advantage plans are:
- Health Maintenance Organizations, or HMOs.
- Preferred Provider Organizations, or PPOs.
- Private Fee-for-Service plans, or PFFS.
- Special Needs Plans, or SNPs (which only serve certain groups of people with Medicare)

If you choose one of these plans, you will have to use hospitals and doctors in the Medicare Advantage plan’s network to save the most money. You will pay higher costs if you use providers outside the network.

There may be Medicare Advantage plans in your region that do not offer prescription drug coverage. Make sure you choose a Medicare plan with prescription drug coverage if you need it.

Most people will pick a plan based on:
- What drugs they use.
- What pharmacy they want to use.
- How much the plan costs.

Whether they want a Medicare plan that covers prescription drugs only (a standalone Medicare Prescription Drug Plan or PDP) or a Medicare Advantage plan with both medical benefits and prescription drug coverage (a Medicare Advantage Prescription Drug plan or MA-PD).

Choose two or three Medicare plans, then call each one for more information. Ask these questions:

1) Are there any limits for my drugs? For example, can I buy as much as I want at a time?
2) Can I buy the drug I want, or do I have to try another drug like it first?
3) Does the Medicare plan have to approve drugs before I buy them?
4) Can I buy my drugs through the mail? If so, how much will I save?
5) How can I get my drugs if I travel a lot?
6) What does it cost to use a drug store that is not in my Medicare network?