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Medicare Drug Benefit


Senior Health Insurance Information Program (SHIIP)


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Explaining Medicare's Drug Benefits

Medicare is health insurance for people who are:

  • 65 and older

  • Under 65 with certain disabilities (who have been receiving Social Security disability benefits for a certain amount of time - 24 months in most cases)

  • People with End-State Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a transplant)

As of January 1, 2006, anyone with Medicare became eligible to join a Medicare prescription drug plan (Part D) to help lower prescription drug costs and help protect against higher costs in the future.


The Center for Medicare and Medicaid Services contracts with private companies offering prescription drug plans to negotiate discounted prices on behalf of their enrollees.  Individuals with Medicare can also receive drug benefits through a Medicare Advantage Plan or another Medicare plan, if enrolled in one. Some employers and unions may also provide coverage to people with Medicare.


Anyone who has Medicare Part A (hospital coverage) and/or Part B (medical coverage) is eligible to join a Medicare prescription drug plan. You must live in a Medicare prescription drug plan service area to enroll in it.


Individuals who live outside of the U.S. or who are incarcerated cannot enroll in a Medicare drug plan. Individuals with limited incomes and resources may be able to get extra help with the costs of Medicare prescription drug coverage. You can apply with either the Social Security Administration or the Department of Human Resources.