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Medicare Prescription Drug Plans (Part D)

Medicare Part D helps cover the cost of prescription medications. Coverage is offered through private insurance companies approved by Medicare and is available through standalone Medicare Prescription Drug Plans or as part of certain Medicare Advantage plans.

Each plan has its own list of covered medications, called a formulary, as well as its own costs and participating pharmacy network. Plan availability and benefits can vary by location.

How Does Medicare Part D Work?

Medicare Part D prescription drug coverage is available through private insurance companies approved by Medicare. You can get Part D coverage through a standalone Prescription Drug Plan (PDP) that works alongside Original Medicare,

or through certain Medicare Advantage plans that include prescription drug coverage.

Each Part D plan has its own formulary, which is the list of prescription drugs the plan covers.

Plans also have participating pharmacy networks, and your costs may vary depending on the medication, pharmacy, and plan you choose.

What Does Medicare Part D Cover?

Medicare Part D plans cover a wide range of prescription medications. Every plan has its own formulary,

so the specific medications covered and what you pay can vary from one plan to another.

Part D formularies generally include both generic and brand-name prescription drugs

and must meet Medicare requirements for covered drug categories.

Your costs can depend on the medication's formulary tier, the pharmacy you use, and the specific Part D plan you select.

Understanding Medicare Part D Costs

The amount you pay for Medicare Part D coverage can vary by plan. Depending on the plan you choose,

your costs may include a monthly premium, deductible, copayments, or coinsurance for prescription medications.

The amount you pay for a prescription can also depend on the drug's formulary tier and whether you use a pharmacy within the plan's network.

Because plan premiums, formularies, pharmacy networks, and prescription drug costs can change,

it is important to review your coverage and medications when comparing Part D plans.

Why Review Your Medicare Part D Coverage Each Year?

Medicare Prescription Drug Plans can change from year to year. A plan may make changes to its formulary,

pharmacy network, premiums, deductibles, copayments, or coinsurance.

Your own prescription needs may also change. Reviewing your coverage each year can help you determine

whether your current plan continues to cover your medications and fits your needs and budget.

During applicable Medicare enrollment periods, you may have an opportunity to compare available Part D options and make changes to your coverage.

Who Can Enroll in Medicare Part D?

To enroll in a Medicare Prescription Drug Plan, you generally must have Medicare Part A and/or Part B and live in the plan’s service area.

You can enroll in or make changes to Medicare prescription drug coverage during certain Medicare enrollment periods.

The enrollment period available to you depends on your individual circumstances and eligibility.

If you delay enrolling in Medicare drug coverage when first eligible and do not have other creditable prescription drug coverage,

you may have to pay a late enrollment penalty if you enroll later.

When Can I Enroll or Change My Medicare Part D Plan?

You may be able to enroll in or change Medicare Part D coverage during certain Medicare enrollment periods,

depending on your circumstances.

When you first become eligible for Medicare, you generally have an Initial Enrollment Period

during which you can enroll in prescription drug coverage.

Medicare also has an Annual Enrollment Period each year from October 15 through December 7,

when eligible beneficiaries can join, switch, or drop Medicare drug coverage for the following year.

Certain life events or changes in circumstances may also qualify you for a Special Enrollment Period.

Talk With a Licensed Medicare Insurance Agent

Have questions about Medicare Part D prescription drug coverage? We can help you review available plan options, compare coverage for your medications, and better understand prescription drug costs and pharmacy networks.