Medicare and Mail Order Prescriptions: What Are the Rules?

In this article...
  • Get the facts about Medicare and mail order prescriptions. Find out when Medicare may cover the cost of medications purchased through a mail order pharmacy.

Nearly 90% of all older adults take at least one prescription medication regularly, and for some, trips to the pharmacy to pick up medications are challenging.

Mail-order pharmacies offer an alternative to visiting the pharmacy in person. If you take prescription drugs, understanding the relationship between Medicare and mail-order prescriptions and knowing the pros and cons of receiving medications through the mail can help you make an informed decision regarding your purchases.

You may be able to find Medicare drug plans available where you live that pay for home delivery of your mail-order prescriptions. Compare plans for free online or request a free quote from a licensed insurance agent.

Types of Medicare and Mail-Order Prescriptions

Whether Medicare will pay for your mail-order prescriptions depends on your plan and policy. 

  • Original Medicare: Medicare Parts A and B (Original Medicare) don't usually pay for prescription drugs regardless of how you fill the prescription.

  • Medicare Part C: Most Medicare Advantage plans (Medicare Part C) include coverage for prescription drugs. If you have one of these policies, you purchase a plan through a private insurer. Your insurance company sets rules for the plan. Many Medicare Advantage plans with prescription drug coverage do allow you to use mail-order pharmacies. However, the plan may only help pay for prescriptions bought through specific ones.

  • Medicare Part D: Medicare Part D is optional prescription coverage for people with Original Medicare. Like Medicare Part C, Medicare drug plans are provided through private insurers. Insurance companies establish rules for mail-order pharmacies for each plan.

Even if your Medicare Part C or Part D plan does allow you to buy prescriptions through mail-order pharmacies, it normally won't pay for 100% of drug costs. With both plans, you will likely have out-of-pocket expenses, such as copays. How much you pay depends on the rules of your plan. You're usually responsible for paying these expenses when you pick drugs up at a brick-and-mortar pharmacy, too.

If the out-of-pocket costs for your prescription drugs cause you financial difficulty, you may qualify for the Extra Help program and other drug cost assistance programs. The Social Security Administration reports that the program provides roughly $5,100 per year to help pay deductibles, copayments and other fees for prescription drugs that meet income requirements.

Benefits of Mail-Order Pharmacies

If your Medicare plan allows you to use a mail-order pharmacy, there are some benefits to opting for the service.

Convenience

Ordering drugs through the mail means you don't have to make a trip to the pharmacy. For older adults who lack transportation or have limited mobility, mail-order pharmacies greatly simplify life. People who frequently forget to drop off, pick up or call to refill prescriptions may benefit from mail-order services.

Are Mail-Order Prescriptions Cheaper Than the Pharmacy?

Mail-order pharmacies often have lower overhead than brick-and-mortar stores. In addition, they often have larger storage facilities than independent pharmacies, meaning they can purchase prescription medications in bulk. Often, these advantages mean that mail-order prescriptions are cheaper, but you'll need to actually compare costs for specific medications to know for sure.

Access to Quick Support

Many online pharmacies offer 24/7 hotlines and online chat services staffed by pharmacists. If you have a question about a medication, you can get assistance at any time of day. You're less likely to receive this type of support when you buy from a local pharmacy.

Drawbacks of Mail-Order Pharmacies

There are some potential drawbacks to mail-order pharmacies that you need to be aware of before you sign up.

Speed of Delivery

Many brick-and-mortar pharmacies allow you to pick up medications within a few hours or the next day. Mail-order pharmacies take longer because your medication requires shipping. In some cases, you may not be able to wait to receive a prescription for an illness or urgent medical condition. As a result, mail-order pharmacies are often better for medications that you take on an ongoing basis rather than antibiotics and other drugs that you take for short periods of time.

Are Mail-Order Pharmacies Reliable?

The reliability of mail-order pharmacies varies. That's why it's important to do research and read online reviews before you sign up for one. Medicare Part C and D plans that name specific mail-order companies for you to use have likely vetted those pharmacies for reliability and customer satisfaction. Still, you can run into problems with even a trustworthy mail-order pharmacy. Sometimes, medications arrive damaged. If this happens, mail-order pharmacies will usually set things right, but you'll have to wait again for your prescriptions to come.

Some Medications May Be Unavailable

Some medications require compounding by a pharmacist. Mail-order pharmacies normally don't offer these medications. Some specialty drugs may also be unavailable through the mail. If you take one of these medications, you'll usually need to special order them through a brick-and-mortar pharmacy.

Am I Automatically Signed Up for a Mail-Order Pharmacy?

In some cases, Medicare Advantage and Part D drug plans sign enrollees up for mail-order pharmacies automatically. If your plan does, you may be able to opt out of participation in the mail-order program.

How Do I Get Prescriptions Delivered to My Home?

Most of the time, your doctor sends your prescription directly to the mail-order pharmacy. The pharmacy then fills your prescription and files a claim with your Medicare Part C or Part D plan. Then, they mail you the prescription. Most of the time, the mail-order pharmacy keeps your credit card or bank account information on file and charges you for any copay or co-insurance that you owe.

Depending on where you live, you may be able to have prescriptions delivered to your home through pharmacy delivery. Some nationwide chains and independent pharmacies offer this service. With home delivery, your doctor sends your prescription to your local pharmacy. When the prescription is ready at your local pharmacy, someone drives the medication to your house. In some cases, you pay a fee for the service on top of whatever copay or coinsurance you owe.

What Is an Automatic Refill Service From a Mail-Order Pharmacy?

Under a standard agreement with a mail-order pharmacy, you either go online or call when you need to refill your prescriptions. Many pharmacies provide an automatic refill service that lets you skip this step. With automatic refills, the mail-order pharmacy keeps track of your prescriptions and ships the refills to you before your medication runs out without you having to notify them. Whether automatic refill service is available to you depends on the rules of your plan and what your mail-order pharmacy offers.

What Are the Best Mail-Order Pharmacies?

Often, the best mail-order pharmacies are those operated by private insurance companies for their subscribers. Aetna, SilverScript, Humana and Mutual of Omaha all have mail-order pharmacy services. Third-party mail-order pharmacies like OptumRx also ship medications throughout the United States. Your plan information will provide you with the rules regarding Medicare and mail-order prescriptions specific to you and list the pharmacies available to you.

Read More
Home Health Nurse With Patient
Aetna and Cigna are among the most well-known health and Medicare insurance companies in the U.S. ...
Doctor speaks with smiling couple in doctor's office
UnitedHealthcare and Humana are two of the largest health insurance companies in the U.S. How do these ...
Man kisses his smiling wife on her cheek
Wellcare and Kaiser Permanente each offer a range of insurance plans, including types of Medicare ...