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Fact Checked

Can You Use a Prescription Discount Card With Medicare?

Finding the right health insurance plan can be daunting. There are numerous companies that offer health insurance coverage and each company has its own choice of multiple coverage plans to choose from. These plans have different coverage of inpatient hospitalization, outpatient care, urgent care, preventative care, and prescription drugs. These plans also have different ‘deductible’ amounts that have to be met before the insurance company will cover your costs for each component. Often, the choice of a health insurance plan is simple because most Americans get their health insurance from their employer. Employers select insurance plans to offer their employees and most of the time, you can choose a plan that suits you best through your employer. There are several important factors to consider when choosing a health plan that is right for you.

  • Is your primary care doctor covered under that plan? If not, are you looking to change to another doctor that is?
  • Are any brand-name prescription drugs that you are currently taken covered under the plan?
  • Do you have a chronic health condition that requires regular medical checkups and inpatient or outpatient treatment?

How much healthcare costs you incur annually usually depends on what kind of insurance plan and coverage you have. One of the main health insurance plans that is managed by the government is Medicare. Senior citizens age 65 years or older are automatically eligible for Medicare. Younger people with permanent disabilities, or people with end-stage renal failure can also get Medicare. 

How to save on Prescription Drugs with Medicare

Prescription discount cards are a great way to save money on prescription drugs. Drug discount cards work because everyone is eligible to apply for them and they are applicable for most FDA-approved prescription drug. How does the discount card work? They can usually be obtained from trusted websites online, like the prescription drug discount card from USA Rx. The discount card is simply presented to the pharmacy when you fill a prescription drug and the savings are automatically applied. 

Unfortunately, you cannot use Medicare coverage along with a prescription discount card, or with a drug coupon. The federal government prohibits pharmaceutical companies from offering discounts on medications purchased with Medicare Coverage. Since prescription drug coupons and drug discount cards fall under this category, you cannot legally use a card or coupon in combination with Medicare. However, you have the option of choosing whether to use Medicare Coverage or a drug discount card on your medication. If you are covered by Medicare, the pharmacist is required by the Center for Medicare and Medicaid Services (CMS) to put the drug under Medicare coverage by default as long as the drug is eligible under the plan. If you decide to use a drug coupon or drug discount card instead of Medicare coverage for reasons that might help you save more on the drug with the discount card, you must specify this to your pharmacy so the drug will not be registered with Medicare when you purchase it. 

How does Medicare work?

There are four parts to Medicare coverage. 

  • Part A covers inpatient hospital care, home health care, and hospice care. Most individuals who have worked for ten years or have a spouse that worked for ten years are automatically eligible for Part A coverage. 
  • Part B covers outpatient care, doctor’s office visits, preventative care like vaccines and screening tests.
  • Part C is known as ‘Medicare Advantage’ and is a bundled plan of Parts A and B. It can also include Part D. This plan is usually offered by private healthcare insurance companies. 
  • Part D covers prescription drugs and can be added to Part A, B or C. 

Often, patients under Medicare coverage end up spending the most on prescription drugs, even with Part D coverage. This can be due to several reasons. 

  • Not all drugs are covered under Medicare Part D. Patients often find that they are prescribed a drug that is not included in the coverage plan and are forced to buy the drug by paying out-of-pocket. 
  • Sometimes, a drug is covered in the previous year, but due to updates in Medicare Part D plan coverage, the drug is no longer covered and what was formerly covered for a patient is now a financial burden for them. 
  • Medicare Part D plan covers drugs that can be purchased from a pharmacy but does not cover drugs that are part of Part A or Part B plans, like drugs that you take during an inpatient hospital stay. This means that certain types of treatment like chemotherapy that are administered in a hospital may not be covered by Medicare Part D. 
  • If you have reached the ‘Donut Hole’ or Coverage Gap of Medicare, you will have to pay out-of-pocket for your prescription drug. The Donut Hole is the gap in coverage of your plan after you and your plan have spent a certain amount of money for the coverage year. In 2019, this amount was $3,820 and patients who reached this amount earlier in the year were forced to pay more out-of-pocket due to decreased coverage. If you reach the Donut Hole, patients with this plan have to pay 25% on brand-name drugs and 37% on prescription drugs. Some patients who have to use expensive brand-name drugs for health conditions often reach the Donut Hole earlier than other patients and this causes quite a financial strain on them.

How to choose between using Medicare or a Drug Discount Card

Under what circumstances is it advantageous to use a drug discount card instead of Medicare? 

  • Your medication is not covered by Medicare Part D. This is a fairly common reason for choosing to use a discount card over Medicare. You will get the drug at a discounted price by using the card. 
  • You have reached the Donut Hole. If you regularly take brand-name medication and have reached the Donut Hole, consider using the drug discount card to help you save on your medication for the remainder of the coverage year. Although you may still have high out-of-pocket costs, it may ease the financial strain of having to purchase the drug. 
  • Every insurance plan has a certain amount of money that you must pay out-of-pocket before they will cover part or all of your drug. This is called the ‘deductible,’ and the amount for Medicare was $415 in 2019. If you rarely take prescription drugs and are not likely to meet the deductible amount, it may make more sense for you to use a drug discount card instead of Medicare. Using this drug discount card in this scenario could cost you less overall than having to pay completely out-of-pocket for the drug before your deductible is met. 

Whether you choose to use Medicare coverage or a drug discount card will be a case-to-case decision based on your health condition, the frequency for which a drug must be purchased and taken, whether that drug is likely to remain on the Medicare Coverage list in the following year, and whether drug discounts are likely to be discontinued for that drug in the near future. If you do decide to use a drug discount card, how can you find one that is right for you? Some drugs discount cards require paying a small fee to purchase. However, there are options for free drug discount cards that can get you the same amount of savings on prescription drugs without having to leave the comfort of your home and without paying a fee. 

How to get the USA Rx Discount Card 

USA Rx offers a free drug discount card that can help you save money on all FDA-approved drugs. The discount card is accepted at more than 90% of pharmacies across the country, including in Alaska and Hawaii. On the website, you can find how much a particular drug will cost with the discount at your preferred pharmacy. This will also help you compare drug prices at various pharmacies to find the one that is best for you. If your preferred pharmacy is not listed, it may still accept the discount card and you can call them or present your card at your pharmacy to find out. By checking the discounted price of drugs on the USA Rx website prior to filling your medication, you will also have an idea of whether you are likely to save more on the drug by using the discount card or by using your Medicare Coverage. This will help you make an informed decision about which method will be better for you, since you cannot use both the discount card and Medicare in combination for the same drug. 

Even if you primarily use Medicare to cover the costs of your prescription drugs, signing up for the drug discount card through USA Rx is still a good idea. If you unexpectedly find that your required drug is no longer on the covered list for Medicare in the following year, you will be prepared with the discount card that can get you a discounted price on the drug. It is important to consider all options when deciding what route is personally best for obtaining your prescription drugs. 

Published March 27th, 2020 by Chris Riley
Fact Checked by Chris Riley

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