Understanding Your Medicare Drug Coverage (Part D)
If you’re a Baltimore resident on Medicare, Medicare Part D can help pay for prescription drugs. To get Part D coverage, you must enroll in a Medicare-approved drug plan.
There are two common ways to get Medicare drug coverage:
A separate Medicare Part D drug plan. This adds drug coverage to Original Medicare. You usually need Medicare Part A and/or Part B to join a separate Part D plan.
A Medicare Advantage Plan with drug coverage. These plans bundle Medicare Part A, Part B, and usually Part D. Before enrolling, call the plan and make sure your medications are covered and ask what yo costs will be.
If you go without Medicare drug coverage for too long after you are first eligible, you may have a Part D late enrollment penalty. If you get Extra Help, you do not have to pay the Part D late enrollment penalty while you have Extra Help.
When Can You Enroll in a Medicare Part D Plan?
You may be able to enroll in or change Medicare drug coverage during these times:
Initial Enrollment Period: Around the time you first become eligible for Medicare.
Medicare Open Enrollment: October 15 through December 7 each year.
Medicare Advantage Open Enrollment: January 1 through March 31 if you already have a Medicare Advantage Plan.
Special Enrollment Periods: Certain life changes or coverage changes may let you enroll or switch plans at other times.
If you qualify for Extra Help, Medicare may automatically enroll you in a Medicare drug plan if you do not already have one. You can choose a different Medicare drug plan if you want.
What is the “Extra Help” program?
Extra Help is a Medicare program for people with limited income and resources. It helps pay Medicare Part D premiums, deductibles, coinsurance, copays, and other drug-plan costs.
For 2026, people with Extra Help generally pay:
Plan premium: $0
Plan deductible: $0
Generic drugs: up to $5.10 each
Brand-name drugs: up to $12.65 each
After total drug costs reach $2,100: $0 for each covered drug
If you also have full Medicaid and are in the Qualified Medicare Beneficiary (QMB) program, Medicare says you will pay no more than $4.90 for each covered drug.
Eligibility Guidelines
Some people get Extra Help automatically. You should get it automatically if you have:
Full Medicaid coverage
Help from a Medicare Savings Program paying your Medicare Part B premium
Supplemental Security Income (SSI) from Social Security
If you do not get Extra Help automatically, you can apply. In most cases, you must be under the income and resource limits.
For 2026, Medicare lists these limits:
Individual: income below $23,940 and resources below $18,090
Married couple: income below $32,460 and resources below $36,100
Resources generally include money in checking and savings accounts, retirement accounts, stocks, and bonds. Medicare and Social Security say not to count your home, vehicles, personal belongings, life insurance, burial plots, irrevocable burial contracts, or back payments from Social Security or SSI.
These limits can change each year. If your income or resources change, you can reapply for Extra Help at any time.
If you think you are paying the wrong amount for prescriptions, call your Medicare drug plan first. You can also call Medicare and ask about your Extra Help status.
If you’re looking for additional guides for community or government programs, you could benefit from, explore bmorebenefits.com!
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