Find a Medicare plan that fits your needs

What does Medicare Part A cover?

Medicare Part A is provided by the federal government and covers care if you are in the hospital or a skilled nursing facility or are receiving home health care. Once you are enrolled in Medicare Part A, you may receive these benefits without having to pay a premium because you have already paid for them through Social Security payroll contributions.

What does Medicare Part B cover?

Medicare Part B is provided by the federal government and covers visits to your doctor's office and other outpatient services and supplies. When you enroll in Medicare Part B, there is a monthly premium requirement. You can choose not to have this coverage.

What does Medicare Part C cover?

Medicare Part C is called Medicare Advantage and you have to get it from a private insurance company that has been approved by Medicare. Generally, these Medicare Advantage Plans (Part C) cover everything in Parts A and B and might include additional benefits such as dental, vision and hearing services. Most Medicare Advantage plans offer Part D prescription drug coverage.

What does Medicare Part D cover?

Medicare Part D covers prescription drugs and you get it from a private insurance company that has been approved by Medicare. Part D adds prescription drug coverage to original Medicare.

Part A and Part B were the first parts of Medicare created by the government. This is why they are often referred to as “Original Medicare.” If you enroll in a Medicare Part C plan, also known as Medicare Advantage, you get a bundled plan that includes Parts A, B and usually D. These plans may have lower out-of-pocket costs and additional benefits.

Generally, you are eligible for Medicare if you are:

• Age 65 or older (regardless of income or medical history) and eligible for Social Security payments and made tax contributions for 10 or more years.
• Younger than age 65 but have certain disabilities or illnesses, such as amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
• Any age but are permanently disabled and have received Social Security benefits for two or more years.
• Any age but have end-stage renal disease (ESRD)/kidney failure that requires dialysis or a kidney transplant.

Here are some ways you can enroll, with help from the Medicare Support Center:*

1. An easy-to-use plan comparison tool can help. Just type in your ZIP code to find plans in your area.
2. Speak with a licensed Medicare agent in person or by phone: 1-855-589-2155 (TTY: 711) Available Monday - Friday 9AM to 6PM ET.
3. Or enroll directly through Medicare

Initial Enrollment Period

There is a seven-month period of time during which you can enroll in Medicare that begins three months prior to the month you turn 65 and ends three months after your birthday month. If you apply prior to your birthday month, your coverage will be effective on the first day of your birthday month.

Annual Enrollment Period

Each year, there is also an annual enrollment period. October 15 through December 7 is the Annual Enrollment Period for Part C (Medicare Advantage Plan) and Part D (prescription drug plan). During this period, you can change your plans or add or drop coverage (coverage begins January 1 of the following year).

Special Enrollment Period

If you didn’t sign up for Part B (or Part A) when you were first eligible because you’re covered under a group health plan based on current employment (your own or spouse’s) or a family member’s (if you have a disability), you can sign up for Part A and/or Part B:

• Anytime you’re still covered by the group health plan.
• During the eight-month period that begins the month after the employment ends or the coverage ends, whichever happens first.

Each year everyone can change their Medicare plan during the Annual Enrollment Period (October 15 to December 7).  There might be exceptions to these timelines if you qualify for extra help paying for prescription drug coverage.

Medicare Part D plans are optional. However, Medicare requires you to have some sort of creditable drug coverage, such as what you might get from your employer or union, that will pay, on average, at least as much as Medicare’s standard prescription drug coverage.

If your drug coverage meets this definition when you sign up for Medicare, you may keep the coverage you have. However, if you don’t have creditable drug coverage, you should enroll in a Part D plan when you are first eligible.

Several factors determine how much you will pay for prescriptions.

The Medicare plan you choose. Each plan sets its own cost-sharing by tier. Check with your plan about incentives.

Whether your pharmacy is inside your plan’s network. Generally, you need to use a pharmacy in your plan's network for the medication to be covered. Some plans have preferred pharmacies where you could save even more.

Whether the drug you take is on the list of covered drugs (formulary). Generally, plans will only cover medications on their formulary.

What tier your medication is on. Plans place their drugs on different tiers that determine costs. Generally, the lower the tier, the less you pay.

With a deductible, you pay the full cost of your medication until you've met the deducible amount.

Whether you qualify for additional subsidies. There are programs available to help people with limited incomes pay prescription drug costs.

Your payments may vary throughout the year, depending on how much you have already spent on prescription drugs. Your cost-sharing will depend on the benefit phase you have reached in your coverage.

Every Medicare prescription drug plan has a list of drugs — also known as a  formulary — that it agrees to cover. When you research a plan, check your list of medications against the prescription drugs on your plan’s list. You’ll also want to see which “tier” it’s been placed into. Generally, the lower the tier, the less you pay. For example, you will often pay less for a drug in Tier 1 than you would in Tier 4. If your prescription isn’t covered, your doctor can contact the insurance company to request a formulary exception. A Medicare plan finder is a useful tool you can use to plug in the names of prescription drugs and find plans in your area that will cover them. View plan finder

The pharmacy you choose is as important to your savings as the plan you select. Many of the plans will require the use of “preferred pharmacies.” These are pharmacies that are part of a network of pharmacies that have contracted with your plan to provide your medications. When you go to a preferred pharmacy, your costs may be lower. An easy-to-use plan finder tool can help you find low-cost Part D plans that have CVS Pharmacy as a preferred pharmacy.

Several factors determine how much you will pay for prescriptions.

• The plan you choose. Each plan sets its own cost-sharing by tier. Check with your plan about incentives. 
• Whether your pharmacy is inside your plan’s network. Generally, you need to use a pharmacy in your plan’s network for the medication to be covered. Some plans have preferred pharmacies where you could save even more. 
• Whether the drug you take is on the list of covered drugs (formulary). Generally, plans will only cover medications on their formulary. 
• What tier your medication is on. Plans place their drugs on different tiers that determine costs. Generally, the lower the tier, the less you pay. 
• Whether your plan has a deductible. With a deductible, you pay the full cost of your medication until you’ve met the deducible amount. 
• Whether you qualify for additional subsidies. There are programs available to help people with limited incomes pay prescription drug costs.

Your payments may vary throughout the year, depending on how much you have already spent on prescription drugs. Your cost-sharing will depend on the benefit phase you have reached in your coverage. 

CVS Pharmacy accepts most Medicare Part D plans and does not endorse any particular plan.

Many plans will have contracts with specific pharmacies that are called “network” pharmacies. If you go outside of the network, you will likely pay more. Plans with “preferred pharmacies” have a contract whereby the pharmacy agrees to accept what the plan covers and pays. By using a preferred pharmacy, you may be able to have even greater savings on copays, coinsurance and deductibles.

Medicare prescription drug plans have a phase called the coverage gap or “donut hole.” When you reach this phase, your cost-sharing may change based upon the type of drugs you are taking. Once your total drug costs reach a certain amount, you will exit the “donut hole” and your plan should contribute more toward your prescription drug costs.

Choosing the right Medicare Part D plan requires time and thought. You might be wondering, “How can I get the lowest-cost Part D plan?” The first step is to think about what type of drug coverage best meets your needs and then look carefully at all the choices before you make a decision. You need to consider:

• Premiums, deductibles and copayments, which vary widely from plan to plan.
• The list of drugs each plan covers, which is called a formulary.
• Where your medications fall on the plan’s drug list. Each plan organizes drug types into tiers, and some tiers require higher copays than others. Are there lower-cost alternatives to the drugs you’re currently taking?
• What pharmacies you will be allowed to use with each plan and the convenience of their locations.
• Whether the plan offers mail order service.
• The geographic extent of the coverage. Is it only local, or will it cover you throughout the country if you need prescriptions while you’re away from home?
• The donut hole, or coverage gap. Does the plan charge a higher premium to cover drugs in the coverage gap? Is the extra cost worth the expanded coverage?

A good way to compare plans is through an easy-to-use plan comparison tool.*