Medicare Pharmacy Home Delivery: What You Need to Know

Medicare Part A and Part B cover inpatient hospital care, home care, and outpatient services. While Medicare parts A and B will cover the cost of medications you receive from professionals at these facilities, the cost of your regular home medications is not covered by these parts of Medicare.

Medicare Part D is an optional part of Medicare that helps you pay for prescription medications.

Medicare Part D costs vary by plan and typically include:

• a monthly premium
• an annual deductible
• copayments or coinsurance
• coverage gaps called the “donut hole”
• catastrophic coverage

To get help paying for your prescription medications, you must enroll in a Medicare Part D prescription drug plan, or in a Medicare Part C—Medicare Advantage—plan that offers Medicare Part A, Part B, and Part D prescription coverage all in one program.

While Medigap, a supplemental Medicare plan, offers coverage in addition to parts A and B, it does not cover prescription medications.

You will usually enroll in Medicare around your 65th birthday. The 3 month period before your 65th birthday, birthday month, and 3 month period after you turn 65 is called the initial enrollment period. During this time, look ahead at your personal health risks and discuss possible medication needs with your doctor to assess your coverage needs.

Late enrollment penalty

If you do not sign up for Medicare Part D when you initially enroll in Medicare, you may pay a penalty if you decide to add Medicare Part D at a later time. How much the penalty will cost you depends on how long you went without prescription drug coverage before adding Part D or other prescription drug coverage.

Medicare decides your penalty amount by multiplying 1 percent of the national base beneficiary premium ($32.74 for 2020) by the number of months you didn’t have prescription drug coverage. This amount is rounded to the nearest $.10 and added to your regular monthly premium for your Medicare Part D plan. Since the national base beneficiary premium changes each year, the penalty amount that is added to your Part D premium may change from one year to the next, too.

This penalty will be added onto your monthly Part D premium for as long as you maintain Medicare Part D coverage. You can ask Medicare to reconsider your penalty, but it may be best to avoid the penalty altogether by signing up for Medicare Part D during your initial enrollment or making sure you have some other kind of prescription drug coverage at all times.

Extra Help

If you qualify for the Extra Help program, you can get additional help paying for the premiums, copays, and deductibles that come with Part D coverage. This program is income-based and can be a great resource for those who qualify.

While Medicare Part D plans are run by private insurance companies, Medicare sets a standard level of coverage that participating plans must meet. Most prescription plans now offer an option to order prescriptions that can be delivered to your home. This way, you don’t need to go to the pharmacy every month.

Your plan decides whether mail-order pharmacy services are offered. If you would like to have this option, ask about it when signing up for a plan.

Medicare allows an automatic mail-order refill option, but your plan should always ask for your approval before filling a new or refill prescription. Some plans may even ask you to give approval each year to continue mail-order service for your prescriptions. Others may need you to confirm and approve the order before each delivery.

You should direct specific questions on how to set up, change, or stop mail-order deliveries to your prescription plan provider.

Tips for prescription drug delivery

• Ask your doctor to write your prescription in two ways: as a standard 30-day supply that you can fill at your local retail pharmacy in an emergency and as a 90-day supply that you can send for fulfillment with a mail-order service.
• Ask your prescription drug provider which mail-order services are covered under your plan.
• You can compare drug prices online by supplier on sites like GoodRx to find the best value.
• You may be able to set up mail-order delivery by phone or online with your prescription drug plan.
• Always check that your plan supports a particular mail-order service before setting up an order to ensure it is covered.
• Review your prior authorization and coverage limits with your plan. This may apply to mail-order prescriptions and it is important to avoid missing a refill of your medications.
• Mail-order or home delivery pharmacies may not be the best option for prescriptions you need immediately or for short-term medications that won’t require refills, such as an antibiotic.

If you have limited mobility or transportation, or are homebound, mail-order pharmacies can make it much easier to get your medications. Mail-order prescriptions typically come in 90-day supplies, so you don’t have to refill your medications as often.

Also, retail pharmacies tend to have higher cost sharing for patients than mail-order pharmacies. This is one reason home delivery may save you money overall.

If you take multiple medications every day or need to manage a chronic health condition, mail-order services may help you stay in compliance with your doctor’s medical plan.

• Medicare Part D covers prescription medication, and there are many different plans to choose from depending on where you live.
• Most plans offer a home delivery option, which makes it easier to fill any long-term prescriptions in a timely manner.
• Contact your plan to make sure home-delivery is an option or select a plan that does offer this service during the enrollment period.
• Mail-order services might also be cheaper than filling them month to month at your local pharmacy, but shop around for specific drug prices from different suppliers.