Medicare Prescription Drug Coverage – Massachusetts

Below is a guide for Medicare prescription drug coverage.

Overview of Medicare coverage: Medicare is a federal health insurance program for retirees age 65 or older and certain disabled people. Medicare Part A covers inpatient hospital care, some skilled nursing facility care and hospice care. Medicare Part B covers physician care, diagnostic x-rays and lab tests and durable medical equipment. Medicare Part D is a federal prescription drug program.

Medicare Prescription Drug Program: Massachusetts: Medicare Part D offers prescription drug coverage to everyone with Medicare.To get Medicare drug coverage, you must join a plan run by an insurance company or other private company approved by Medicare. Each plan can vary in cost and drugs covered. The Medicare Plan Finder is a search tool can help you do a general program search or find a personal plan for you.

How to get Medicare Drug Coverage: Read about the 2 ways to get Medicare prescription drug coverage–either through adding a Medicare Prescription Drug Plan (Part D), or getting a Medicare Advantage Plan (Part C) such as an HMO or PPO that offers Medicare prescription drug coverage.

Prescription Drug Costs: Each Medicare prescription drug plan has a list of covered drugs. A drug in a lower tier generally will cost you less than a drug in a higher tier. In some cases, if your drug is on a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you or your prescriber can ask your plan for an exception to get a lower co-payment.

***  Starting in early 2016, in most cases, your prescribers need to be enrolled in Medicare or have an “opt-out” request on file with Medicare for your prescriptions to be covered by your Medicare drug plan. If your prescriber isn’t enrolled or has “opted-out,” you’ll still be able to get a 3-month provisional fill of your prescription. This will give your prescriber time to enroll, or you time to find a new prescriber who’s enrolled. Contact your plan or your prescribers for more information.

Medicare Part D for People with an Intellectual Disability:  Department of Developmental Services (DDS) information about Medicare Part D coverage for people who receive DDS services.

How and When Can I Join a Medicare Health or Drug Plan?  Information on how to sign up for Medicaid drug plans.

How Medicaid Prescription Drug Plan Works with Other Coverages: Look here to find out how Medicare Part D works with other insurance.

Medicare Forms, Help and Resources


Fact Sheet last updated on: 4/23/2019