Medicare Part D
Prescription drug coverage or PDP
Medicare Part D prescription drug coverage, often referred to as Part D or PDP.
Part D is provided and coordinated by Medicare-approved private insurance companies. Any beneficiary who is eligible for Original Medicare, Part A and/or Part B, and permanently resides in the service area of a Medicare Prescription Drug Plan, can sign-up for Medicare Part D.
Medicare Part D coverage is optional, but if you don’t enroll in Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later.
How to get prescription drug coverage
There are two ways to get prescription drug coverage
Medicare Prescription Drug Plan (Part D). These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.
If you decide not to get Medicare drug coverage when you're first eligible, you'll likely pay a late enrollment penalty if you join later, unless one of these applies:
You have other
creditable prescription drug coverage
You get Extra Help
Generally, you'll pay this penalty for as long as you have Medicare prescription drug coverage.
To get Medicare drug coverage, you must join a Medicare plan that offers prescription drug coverage. Each plan can vary in cost and drugs covered.
Costs for Medicare drug coverage
You'll make these payments throughout the year in a Medicare drug plan:
Premium
Yearly deductible
Copayments or coinsurance
Costs in the coverage gap
Costs if you get Extra Help
Costs if you pay a late enrollment penalty
Your actual drug plan costs will vary depending on:
The drugs you use
The plan you choose
Whether you go to a pharmacy in your plan's network
Whether the drugs you use are on your plan's formulary
Whether you get Extra Help paying your Medicare Part D costs
Contact us today to get quotes on drug plans available in your zip code.
What drug plans cover
Each Medicare drug plan must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different "tiers" on their formularies.
To lower costs, many plans place drugs into different “tiers” on their formularies. Each plan can divide its tiers in different ways. Each tier costs a different amount. Generally, a drug in a lower tier will cost you less than a drug in a higher tier.
Here's an example of a plan's tiers (your plan’s tiers may be different):
Tier 1—lowest copayment: most generic prescription drugs
Tier 2—medium copayment: preferred, brand-name prescription drugs
Tier 3—higher copayment: non-preferred, brand-name prescription drugs
Specialty tier—highest copayment: very high cost prescription drugs
In some cases, if your drug is in a higher tier and your prescriber thinks you need that drug instead of a similar drug on a lower tier, you can file an exception and ask your plan for a lower copayment.
Consider all your drug coverage choices
Before you make a decision, learn how prescription drug coverage works with your other drug coverage. For example, you may have drug coverage from an employer or union, TRICARE, the Department of Veterans Affairs (VA), the Indian Health Service, or a Medicare Supplement Insurance (Medigap) policy. Compare your current coverage to Medicare drug coverage. The drug coverage you already have may change because of Medicare drug coverage, so consider all your coverage options.
If you have (or are eligible for) other types of drug coverage, read all the materials you get from your insurer or plan provider. Talk to your benefits administrator, insurer, or plan provider before you make any changes to your current coverage.
Joining a Medicare drug plan may affect your Medicare Advantage Plan
Your Medicare Advantage Plan (Part C) will disenroll you and you'll go back to Original Medicare if both of these apply:
Your Medicare Advantage Plan includes prescription drug coverage.
You join a Medicare Prescription Drug Plan (Part D)