New Retirees: Your Drug Coverage May Be Worse on Medicare
What's it say
A recent GoodRx study reveals that retirees transitioning to Medicare may face less comprehensive drug coverage than their previous employer-sponsored plans. Medicare plans typically exclude 44% of medications, significantly more than the 21% exclusion rate in commercial insurance.
Nearly half of Medicare-covered drugs come with additional restrictions, such as prior authorization and step therapy, potentially leading to delays or denied prescriptions. The average monthly premium for stand-alone Part D plans in 2025 is $46.50, whereas Medicare Advantage averages $17, often bundling drug coverage.
Still, Advantage plans frequently impose tighter care restrictions. Experts advise new Medicare enrollees to thoroughly check medication coverage, consult healthcare providers proactively, and consider discount services like GoodRx—though spending on these services doesn't count toward Medicare deductibles.
Carol's comments
Switching from employer insurance to Medicare is a bit like trading your trusty SUV for a compact sedan—it still runs, but you might miss the extra room! Employer plans often offer broader medication coverage and fewer barriers.
Traditional Medicare, combined with a Supplement and a Part D plan, typically provides greater flexibility with fewer restrictions than Medicare Advantage.
Why it matters to you
If you're nearing Medicare age, be ready to navigate changes in your drug coverage. Reviewing your medications against potential Medicare plans annually, involving your doctor in planning, and leveraging discount programs can help keep costs manageable.