What is Medicare Part D?
Medicare Part D, also known as the Medicare Prescription Drug Plan, is an optional benefit that provides assistance with the cost of prescription medications. Medicare Part D is offered by Medicare-approved private insurance companies in coordination with Centers for Medicare and Medicaid Services (CMS). Medicare Part D may help lower your current prescription drug costs, and it may protect you against higher costs in the future. Open enrollment occurs annually from October 15 through December 7. Individuals can enroll for the first time, select alternative coverage or renew existing coverage. Just remember, if you miss the enrollment window you may have to pay a late fee penalty.
All Medicare recipients are eligible for Medicare Part D. If you’re entitled to Medicare Part A, or you’re enrolled in Medicare Part B, you cannot be turned down for a Medicare Part D plan during your initial enrollment period. During the enrollment period, you can choose either a Medicare Advantage plan that includes prescription coverage, or a Medicare Part D plan.
It’s very important to carefully choose your Prescription Drug Plan. Each Prescription Drug Plan has a specific “formulary list,” or list of covered drugs. Prescription Drug Plans can vary wildly in price and coverage because they’re administered by private insurance companies. There are guidelines set by the federal government to ensure certain drugs are covered under all Medicare Part D Plans. Make sure the prescriptions you’re currently using are on the formulary list for the plan you select, and that your Pharmacy is included in the plan’s network.
Finally, please be aware that your plan may change its formulary. Every fall, it’s a good idea to review the Annual Notice of Change sent to you by your plan, and make sure that in the coming year it will still cover your prescription medications.
Your actual costs for Medicare Part D prescription drug coverage will vary depending on:
- Which prescriptions you take, and how often
- Whether you choose a standalone Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug Plan
- Whether you visit a Pharmacy in your plan’s network
- Whether your prescription drugs are on your Medicare Part D plan’s formulary (list of covered drugs)*
In general, most individuals will pay a premium each month for coverage. This will vary depending on the level of coverage of fered by the plan you have selected. There will be an initial deductible where you will pay the full cost of your medications until you’ve satisfied your deductible. Once your deductible is met, the terms of your plan will specify the share of the costs that you will pay for your medications.
There is a secondary coverage gap, often called the “donut hole,” that may temporarily occur once your Prescription Drug Plan has paid a certain maximum amount towards your medications. More details about the specific coverage of each Prescription Drug Plan can be provided by the insurance company that administers the plan.
When you age into Medicare at 65, you’ll have an opportunity to enroll in a prescription drug plan. You may enroll during the next Annual Enrollment Period (AEP) if you do not enroll during your Initial Enrollment Period.
Please visit Medicare.gov for additional information on Medicare Part D.**
*Remember that formularies may change at any time. You’ll be notified by your Medicare plan if necessary.
**Information on this page was referenced from Medicare.gov.