If you have Original Medicare, you know it doesn’t include coverage for most prescription medications. That’s where Medicare Part D plans come in.
Medicare Part D offers prescription drug coverage with Medicare. This coverage comes from private insurance companies approved by Medicare. It helps you pay for the medications you need.
Who Is Eligible for Medicare Part D?
You can enroll in a Medicare Prescription Drug Plan (PDP) if you’re eligible for Medicare Part A and/or Part B. It’s best to enroll when you first become eligible—if you delay, you might face a late enrollment penalty unless you have other creditable drug coverage.
What Is a Medicare Part D Formulary?
Each Part D plan has a formulary, or list of covered prescription drugs. Formularies vary by insurance company and plan. They include both generic and brand-name prescription drugs, which are organized into tiers.
Lower-tier drugs usually have lower cost sharing, like copays, while higher-tier drugs can have higher out-of-pocket costs. Before you enroll, check the plan’s formulary to make sure your medications are covered. Our licensed agents can help you compare formularies, pharmacy networks, and plan costs so you find the right Medicare drug coverage.
Medicare Part D Costs
Your costs for a Medicare Part D plan will depend on the plan you choose, your income, and the medications you take. Health care costs can include:
- Monthly premiums: Each plan sets its own premium. Some people with limited income may qualify for programs to help pay these premiums.
- Annual deductible: Some plans require you to pay a deductible before your plan starts to cover your prescription drugs.
- Copayments or coinsurance: After your deductible is met, you’ll pay copays or coinsurance for each prescription, based on the drug’s tier.
Medicare Part D Coverage Stages
Most Medicare Part D plans have stages that determine what you pay throughout the year:
Deductible Stage: You pay the full cost of your prescriptions until you meet your plan’s deductible.
Initial Coverage Stage: After the deductible, your plan shares the cost with you through copays or coinsurance.
Catastrophic Coverage Stage: Once your total out-of-pocket costs reach the annual limit, you’ll pay a small copay—or nothing at all—for the rest of the year.
These stages help you predict your potential costs and plan your budget.
Medicare Part D and Medicare Advantage
You can get Medicare prescription drug coverage in two ways. You can choose a stand-alone Medicare Part D plan. Or, you can enroll in some Medicare Advantage plans (MA-PDs) that include drug coverage. Not all Medicare Advantage plans include prescription benefits, so it’s important to compare plan options carefully.
When to Enroll in Medicare Part D
The best time to enroll is when you’re first eligible for Medicare. However, you can also enroll during:
- Annual Open Enrollment (October 15 – December 7): Switch or join a Part D plan for the upcoming year.
- Medicare Advantage Open Enrollment (January 1 – March 31): If you’re in a Medicare Advantage plan, you can switch to another plan or return to Original Medicare and join a Part D plan.
How O’Neal Insurance Group Can Help
Choosing the right Medicare Part D plan can feel overwhelming. Our team at O’Neal Insurance Group is here to help you.
We can compare plan premiums, deductibles, and drug lists. We will review pharmacy network options near you. We can help you avoid costly late enrollment penalties.
We will explain cost sharing and how each plan covers your medications. Our goal is to find a plan that fits your health needs and budget.
Frequently Asked Questions About Medicare Part D
What does Medicare Part D cover?
Medicare Part D plans cover prescription drugs that you pick up from a pharmacy. Each plan has a formulary listing which medications are covered. Coverage includes many common generic and brand-name drugs, but formularies vary by plan.
How do I enroll in a Medicare Part D plan?
You can sign up when you first qualify for Medicare. You can sign up during the Annual Open Enrollment Period. This period is from October 15 to December 7 every year. You can also switch plans during this period.
Can I change my Medicare Part D plan later?
Yes. You can change your Medicare prescription drug plan each year during the Annual Open Enrollment Period. This allows you to find a plan that better fits your current medications or budget.
Do I need Medicare Part D if I have other drug coverage?
If you have other creditable drug coverage, you may not need Part D right away. If your other coverage ends, you should sign up for a Medicare Part D plan right away. This will help you avoid late enrollment penalties.
What happens if I don’t enroll in Medicare Part D when I’m first eligible?
If you do not have other creditable coverage and wait to enroll in Part D, you may face a late enrollment penalty. This penalty can last as long as you have Medicare drug coverage.
*Disclaimer: This page has not been reviewed or endorsed by Medicare.gov or any member of the Centers for Medicare & Medicaid Services (CMS).
