Many people are confused when they first hear that Medicare may not cover all of their prescription drug coverage needs. In order to have drug coverage included as part of your Medicare, you must enroll in a Medicare Part D program. Part D is an “add on” to the standard coverage provided by Medicare Part A and B. You become eligible to enroll in Part D as soon as you are eligible for Part A and B. However, Part D does not cover every prescription medication you might need — in fact, it may completely fail to cover some medications.

Medicare Part D coverage is based on what’s known as a “formulary.” This is a document that is produced and updated by Medicare officials each and every year. The prescription medications included on the formulary are those that you can get covered. Anything not on the formulary is not subject to any Medicare coverage. While this is a potentially scary thought, one should also realize that the vast majority of the most common medications will always be included — and if you do require a medication that isn’t included, it may be adopted in future updates of the formulary.


However, it’s true that you can also obtain drug coverage — similar to, but different from Medicare Part D — if you are a Medicaid recipient. Unlike Medicare, which is tuned to your age and first becomes available to you at age 65, Medicaid is based upon your earnings. All Medicaid benefits accrue to a potential beneficiary if their annual income is below a certain standard. Unlike Medicare, this standard tends to differ from state to state, based on factors related to the cost of living in each place. If you suffer from a permanent disability or have limited resources, you may qualify.

Medicaid coverage differs from state to state, while Medicare Part D coverage is much more likely to differ from year to year and by provider. Part D coverage is much more costly to maintain than anything that you might qualify under Medicaid, no matter where you happen to live. However, even if it is sometimes unexpectedly costly, it will always save you money in the long run if you are on prescription medication for several months. If you no longer need medication, then you can consider changing or even dropping your Part D coverage during specific times of the year.