Learn how to navigate Medicare prescription coverage, avoid common medication myths, and make informed choices that protect both your health and your wallet as you age.
As we age, many of us take medications to manage different health conditions, stay healthy, and maintain a good quality of life. At the same time, we also enroll in Medicare to help cover the costs of those prescriptions. Unfortunately, things like changing drug prices, coverage rules, and misleading advice found online or shared by word of mouth make it easy for misinformation to spread. This can lead to costly mistakes and problems in the long run.
Understanding how Medicare and prescription drug coverage work can help you avoid confusion and stay on track with your medications. Here’s a guide for older adults on medication, Medicare, and misinformation.
How to Stay Informed
You don’t need to become a Medicare expert overnight, but it helps to know where to go for accurate and up-to-date information. One of the best resources is the official Medicare website, Medicare.gov, where you can compare Part D and Medicare Advantage plans and review cost estimates. The website also has a lot of resources on official Medicare coverage information, so you can learn more straight from the source.
Many people also wonder, “Do I need a broker or agent?” While it’s not required, working with a licensed Medicare insurance broker can be a big help. They can explain plan details, help you compare options based on your specific prescriptions, and make sure you’re not missing out on benefits like Extra Help, a program that reduces drug costs for people with limited income and resources.
It’s also a good idea to review your drug coverage and change it if needed every year during Medicare’s Annual Election Period, which runs from October 15 to December 7. Plans can change their drug lists, premiums, and pharmacy networks each year, and the plan that worked for you last year may no longer be the most cost-effective.
How Medicare Covers Medications
Medicare drug coverage works differently than some people expect. Original Medicare, Part A and Part B, doesn’t include prescription drug insurance for medications you receive from the pharmacy. For this coverage, you’ll need to enroll in a stand-alone Medicare Part D plan or a Medicare Advantage plan that includes built-in Part D insurance.
Part D plans are offered by private insurance companies approved by Medicare. Each plan has its own list of covered drugs, known as a drug formulary. Exact costs vary depending on the plan, the pharmacy you use, and the medications you take.
It’s also important to understand that drug costs under Part D fall into three stages: deductible, initial coverage, and catastrophic coverage. Not everyone reaches each stage, but knowing how each works can help explain changes in out-of-pocket costs throughout the year.
Why It’s Easy to Get Misinformed
There’s a lot of information about Medicare and medications online, in advertisements, and in conversations with friends or neighbors. Unfortunately, this information is not always correct, or it may only apply to specific situations. For example, someone might say that Medicare pays for all diabetes supplies, but forget to mention that certain types need to be ordered through durable medical equipment providers under Part B, while others fall under Part D. That kind of half-truth can lead to confusion, billing problems, or delays in getting what you need.
Another common source of confusion is how drug pricing works. You might hear someone say a drug used to cost $5 and now it’s $100. They blame Medicare when it may actually be due to changes in the plan’s formulary. In addition to the drug’s tier, or the pharmacy network. What worked for someone else’s plan last year may not apply to yours today.
Additionally, some websites promote products or services without clearly stating whether Medicare endorses them. Others may post outdated or inaccurate articles that sound authoritative but don’t reflect current laws or policies. Scams also target older adults. They are trying to trick them into signing up for “free” benefits or programs. Really, that don’t exist or only apply to specific groups of people.
Final Thoughts
Being informed makes a big difference when it comes to medications and Medicare. The system can be complicated. But there are tools and support available to help you navigate your coverage. And stay on your prescriptions, and avoid costly mistakes.