Medicare: Common Situations

medicare medicaid

medicare medicaid

To help you get started thinking about Medicare drug coverage, find the situation that describes you and learn what you need to do.

“I have Original Medicare only, or Original Medicare and a Medigap (‘Supplement’) Policy without drug coverage.”If you use an average amount of prescription drugs, Medicare’s new prescription drug coverage could pay over half of your drug costs next year. If you have very high unexpected drug costs, Medicare will pay up to 95% of these costs after you spend $3,600 out-of- pocket in a year.

What you need to do:
To get this drug coverage, you can join a Medicare Prescription Drug Plan that covers prescription drugs only and keep your Original Medicare coverage the way it is. Or you can join a Medicare Advantage Plan or other Medicare Health Plan that covers doctor and hospital care as well as prescriptions.

Medicare Advantage Plans usually give you extra benefits and/or lower costs, but only if you use the doctors and hospitals that participate in the plan’s “network.” If you do not opt for prescription drug coverage by May 15, 2006, you will have to pay a late enrollment penalty to get drug coverage later.

“I have Original Medicare and a Medigap (‘Supplement’) Policy with drug coverage.”Medicare prescription drug coverage will generally provide significant savings compared to what you are paying in copayments for drugs under your Medigap plan, and will generally provide much better protection against unexpected drug expenses as well.