How Part D works with other Insurance
State Programs | Federal Programs
It is important to understand how your prescription drug coverage works with government issued insurance and other state and private insurance programs.
State and Private Programs
State Programs | Federal Programs
Medicaid: If you have both Medicare and full-scope Medicaid (the highest level of state financial assistance), Medicare covers a majority of your prescription drugs. Medicaid may pay for the drugs that Medicare does not cover.
Employer or Union Coverage: If you have prescription drug coverage based on your current or previous employment, your employer or union will notify you each year to let you know if your prescription drug coverage is creditable. Keep all records from your employer regarding coverage in case you need to provide proof of coverage later on.
**If you join a Part D plan or Medicare Advantage plan that includes prescription drug coverage, your spouse and dependents may lose your employer or union coverage**
COBRA: If you take COBRA and it includes creditable prescription drug coverage, you’ll have a Special Enrollment Period to join a Medicare drug plan without paying a penalty when the COBRA coverage ends. We always recommend contacting your State Health Insurance Assistance Program (SHIP) if you have questions about COBRA.
Medicare Supplement (Medigap) that includes prescription drug coverage: This is rare. Medicare supplements (Medigap) are not allowed to include prescription drug coverage anymore because the drug coverage did not qualify as creditable coverage under Medicare. However, some individuals may still have Medigap plans that have some drug coverage on it. When joining a new stand alone Part D plan, simply notify your current Medigap company of your new prescription drug coverage so that they can remove your current Medigap non-creditable prescription coverage. Call your Medigap insurance company for more information.
Federal Government Programs
State Programs | Federal Programs
These programs are all considered ‘creditable prescription drug coverage’:
Federal Employee Health Benefits (FEHB) Program: This is health coverage for current and retired federal employees and covered family members. Most FEHB plans already include creditable prescription drug coverage however you still have the choice to join a stand alone Part D plan. If you do join a stand alone Part D plan you can still keep your FEHB benefits. For more information, visit opm.gov/healthcare-insurance/healthcare, or call the Office of Personnel Management at 1-888-767-6738. TTY users can call 1-800-878-5707. If you’re an active federal employee, contact your Benefits Officer. Visit apps.opm.gov/abo for a list of Benefits Officers. You can also call your plan if you have questions.
Veterans’ Benefits (VA): You may be able to get creditable prescription drug coverage through the VA (US Department of Veteran’s Affairs). You are free to join a stand alone prescription drug plan but you’ll need to choose because you cannot use both drug coverages at the same time. For more information, visit va.gov, or call the VA at 1-800-827-1000. TTY users can call 1-800-829-4833.
TRICARE (military health benefits): Most people with TRICARE who are entitled to Part A must have Part B to keep TRICARE prescription drug benefits. If you have TRICARE, you don’t need to join a Medicare Prescription Drug Plan. However, if you do, your Medicare Prescription Drug Plan pays first, and TRICARE pays second.
If you join a Medicare Advantage Plan with prescription drug coverage, your Medicare Advantage Plan and TRICARE may coordinate their benefits if your Medicare Advantage Plan network pharmacy is also a TRICARE network pharmacy. Otherwise, you can file your own claim to get paid back for your out-of-pocket expenses. For more information, visit tricare.mil, or call the TRICARE Pharmacy Program at 1-877-363-1303. TTY users can call 1-877-540-6261.
Indian Health Service (IHS): If you receive your prescription drugs through an Indian health facility, your coverage will not be interrupted and you will continue to receive medication for no cost.
According to Medicare, joining a Medicare drug plan may help your Indian health facility because the drug plan pays the Indian health facility for the cost of your prescriptions.
Talk to your local Indian health benefits coordinator who can help you choose a plan that meets your needs and tell you how Medicare works with the Indian health care system.
**If you’re getting care through an IHS or tribal health facility or program without being charged, you can continue to do so for some or all of your care. Getting Medicare doesn’t affect your ability to get services through the IHS and tribal health facilities.**
Curious about how your current insurance might affect your Part D? Need advice? We’re here for you! Let our friendly team of ‘Even Better’ Medicare plan experts assist you today and in the future!