Most Medicare plans that include prescription drug coverage also include the option for home delivery. Pharmacies that have a mail-order option will usually provide this service.
A person with Medicare Part D can typically get their prescription medications delivered to their home. Individuals with Medicare Advantage (Part C) may also have this benefit, but rules may apply.
Older adults may take several medications that multiple doctors may prescribe. Filling prescriptions at one pharmacy, especially if it offers home delivery, may be helpful.
This article discusses how people with Medicare may get their prescriptions delivered by mail order from one pharmacy.
Glossary of Medicare terms
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare does offer coverage for the delivery of prescription medications to a person’s home.
Prescriptions are paid for by Medicare Part D, also known as prescription drug plans (PDPs). Private insurance companies administer PDPs, and they must follow Medicare rules.
One of the rules for Medicare Part D plans is that they must have a network of pharmacies from which a person may choose. The plan cannot make a person order from a mail-order service. However, they can offer this service as an option.
Mail-order pharmacy services can be a cost-saving and straightforward way to get medication, both for the initial prescription and refills.
Some services offer automatic refills. The mail-order service estimates when the prescription will run out based on the number of tablets and frequency of doses. The pharmacy will send out the new prescription before the old one runs out.
Some plans ask for confirmation before sending the next refill, while other plans ask for approval only once each year.
To avoid a delay in receiving a prescription, it is important for individuals to make sure their contact information stays up to date with the pharmacy.
Medicare Parts A and B are known as Original Medicare. Part A pays for medication when a person is in the hospital or a skilled nursing facility.
Part B may pay for certain drugs, such as those that must be given in a doctor’s office.
However, a person with Original Medicare needs Part D to help pay for the prescription drugs they take at home.
Medicare Advantage (Part C) plans bundle the same services as parts A and B. They also generally offer prescription drug coverage plans.
Medicare Advantage plans may have lower out-of-pocket costs. However, a person should compare plans to find the most suitable plan for their eligibility and medical needs.
Medicare Part D is an optional benefit. A person is eligible for Part D at the same time they become eligible for Medicare Parts A and B. This is known as the initial enrollment period.
A person can choose not to enroll in Part D when they are first eligible. However, if they join later, it may result in a late enrollment penalty.
The Medicare Part D late enrollment penalty amount depends on how long an individual remained without prescription drug coverage.
Medicare calculates the penalty by multiplying 1% of the national beneficiary premium by the number of months the person did not have Part D or other credible drug coverage. In 2024, the national beneficiary premium is $34.70.
Once the penalty is calculated, Medicare adds it to a person’s monthly Part D premium.
Late penalty example
Here is an example of a Part D late penalty:
If an individual is without prescription drug coverage for 29 months, their penalty is 29% of $34.70. This equals $10.06. However, penalties are always rounded to the nearest $0.10. This means in the example, the penalty per month will be $10.10.
Here is how the math works out:
0.29 x 34.70 = $10.06
$10.06 rounded to the nearest $0.10 = $10.10
$10.10 = the total monthly late penalty due
Usually, a person will pay the penalty for as long as they have the Part D plan. However, the penalty can sometimes be avoided if:
- an individual has other medication coverage that pays at least as much as Medicare’s standard coverage
- a person qualifies for Extra Help by meeting the income and resource limits, which are $17,220 for an individual and $34,360 for a couple in 2024
How to get Part D coverage
A person has two ways of enrolling in a PDP:
- If an individual has Original Medicare, they may enroll in a stand-alone PDP with a private insurance company.
- A person may enroll in a Medicare Advantage plan, which includes prescription drug coverage.
A person cannot have a stand-alone Part D plan at the same time as a Medicare Advantage or Medigap policy that includes coverage for prescription drugs.
Both plans will remove their drug coverage once a Part D plan begins, and this could result in an adjustment to monthly premiums.
A person can find and compare Part D plans in their area using the Medicare plan finder tool.
Part D and other insurance
Medicare has rules about how Part D plans can work with other insurance plans. A person may wish to check with their plan provider to see how other insurance may affect benefits.
Other insurance may include:
- employer coverage
- union insurance
- Medicaid
- Supplemental Security Income (SSI)
- state pharmaceutical assistance
- health insurance marketplace
- veteran’s benefits
- TRICARE
- Federal Employee Health Benefits (FEHB)
A person’s PDP will typically include a network of participating pharmacies.
To get prescriptions by home delivery, an individual should contact their plan provider. Many provide the option of enrolling online or by phone.
A membership with the service will be activated, and the pharmacy will contact the doctor for full prescription details.
Like other services, having prescription medication delivered to a person’s home has advantages and disadvantages.
Sometimes an individual may avoid having medication delivered because additional charges may apply. However, most pharmacies do not charge an extra amount to mail a person’s prescription. This is because it also saves the pharmacy time and money.
Local retail pharmacies may offer delivery systems, or a person may choose a national mail-order pharmacy.
Pros
- Saves time: The person does not need to make a weekly or monthly trip to a pharmacy. Often, with just a click on a computer, a person can order their medication.
- Saves money: Mail-order drugs may be less expensive. It also saves money on the cost of traveling to the pharmacy.
- Automatic refills: Most pharmacies will contact a person’s doctor directly.
- Safety: When one pharmacy fills all prescriptions, it may be easier to identify drugs that do not work well together.
- Face-to-face contact: A person using home delivery from a local pharmacy may still have the option to visit and ask questions in person.
Cons
- Delivery delays: Prescriptions can sometimes take longer to be delivered. A person may also need to collect the first fill of their prescription from a local pharmacy before starting automatic refills through home delivery.
- Lost medications: It is unusual, but occasionally packages can go missing in the mail, and re-shipping the prescription may take time.
- Limited contact options: A person using a national mail-order pharmacy may only be able to contact the company by phone.
Medicare Part D pays for prescription drugs people take at home. Private companies sell Part D policies. Most have the option of delivery at home.
A person’s Part D policy should have a network of pharmacies from which people can buy prescription medication.
Plans that offer delivery will have information on how people may sign up and get their prescribed drugs delivered.
There are pros and cons to having medication delivered at home. If a person chooses the service, they can cancel at any time.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.