- Employer or union health coverage
This is health coverage from your, your spouse’s, or other family member’s current or former employer or union. If you have drug coverage based on your current or previous employment, your employer or union will notify you each year to let you know if your drug coverage is creditable. Keep the information you get. Call your benefits administrator for more information before making any changes to your coverage.
Call your benefits administrator before you make any changes, or sign up for Medicare drug coverage. If you have employer or union coverage and get Medicare drug coverage, you may lose your employer or union health and drug coverage (for you and your dependents) even if you qualify for Extra Help. If this happens, you may not be able to get your employer or union coverage back.
There may be reasons why you should take Medicare drug coverage instead of, or in addition to, COBRA. If you take COBRA and it includes
Talk with your State Health Insurance Assistance Program (SHIP) to see if COBRA is a good choice for you. If you have questions about Medicare and COBRA, call the Benefits Coordination & Recovery Center at 1-855-798-2627 (TTY: 1-855-797-2627).
- Medicare Supplement Insurance (Medigap) policy with prescription drug coverage
It may be to your advantage to join a Medicare 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 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
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 drug plan for Medicare to cover your drugs. You automatically qualify for
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 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 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 drug plan.
If you qualify for
, 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.
- Food stamps
If you get food stamps, you may want to join a Medicare drug plan. If you qualify for
, 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
A service that helps people shop for and enroll in affordable health insurance. The federal government operates the Marketplace, available at HealthCare.gov, for most states. Some states run their own Marketplaces.
The Health Insurance Marketplace (also known as the “Marketplace” or “exchange”) provides health plan shopping and enrollment services through websites, call centers, and in-person help.
The types of insurance listed below are all considered
. 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
This is health coverage for current and retired federal employees and covered family members. These plans include creditable prescription drug coverage, so you don’t need to get Medicare drug coverage. However, if you decide to get Medicare drug coverage, you can keep your FEHB plan, and in most cases, the Medicare plan will pay first. For more information, visit opm.gov/healthcare-insurance/healthcare, or call the Office of Personnel Management at 1‑888‑767‑6738. Visit opm.gov/retirement-services/benefits-officers-center/agency-benefits-officers for a list of Benefits Officers. You can also call your plan if you have questions.
- Veterans' Benefits
This is health coverage for veterans and people who have served in the U.S. military. You may be able to get drug coverage through the U.S. Department of Veterans Affairs (VA) program. You may join a Medicare drug plan, but if you do, you can’t use both types of coverage for the same drug at the same time. For more information, contact the VA.
- TRICARE (military health benefits)
This is a health care plan for active‑duty service members, military retirees, and their families. Most people with TRICARE entitled to Part A must have Part B to keep TRICARE drug benefits. If you have TRICARE, you don’t need to join a Medicare drug plan. However, if you do, your Medicare drug plan pays first, and TRICARE pays second.
If you join a Medicare Advantage Plan with drug coverage, your Medicare Advantage Plan and TRICARE may coordinate their benefits if your Medicare Advantage Plan network pharmacy is also a TRICARE network pharmacy. Otherwise, you can file your own claim to get paid back for your out-of-pocket costs. For more information, visit tricare.mil, or call the contact the TRICARE Pharmacy Program at 1-877-363-1303. TTY users can call 1‑877‑540‑6261.
- Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA)
This is a comprehensive health care program in which the Department of Veterans Affairs shares the cost of covered health care services and supplies with eligible beneficiaries. You may join a Medicare drug plan, but if you do, you won’t be able to use the Meds by Mail program which can give your maintenance drugs to you at no charge (no premiums, deductibles, and copayments). For more information, visit va.gov/communitycare/programs/dependents/champva/ or call CHAMPVA at 800-733-8387.
- Indian Health Services
The IHS is the primary health care provider to the American Indian/Alaska Native Medicare population. The Indian health care system, consisting of tribal, urban, and federally operated IHS health programs, delivers a spectrum of clinical and preventive health services through a network of hospitals, clinics, and other entities. Many Indian health facilities participate in the Medicare drug program. If you get 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 drug plan or Medicare Advantage Plan with drug coverage may help your Indian health facility because the plan pays the Indian health facility for the cost of your drugs.
Talk to your local Indian health benefits coordinator who can help you choose a plan that meets your needs and 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.