Medicare Part D – Prescription Drug Coverage
Medicare Part D provides prescription drug coverage to help individuals manage the cost of medications. This coverage is offered through private insurance companies approved by Medicare and can be obtained through a standalone prescription drug plan or included as part of a Medicare Advantage plan that offers drug coverage.
Prescription drug plans vary in the medications they cover, monthly premiums, deductibles, copayments, and pharmacy networks. Each plan maintains a list of covered medications, known as a formulary. Some medications may require special approval, have quantity limits, or require trying a lower-cost alternative before coverage is approved.
When comparing Part D plans, it's important to review the medications you currently take, the pharmacies you prefer, and the total anticipated cost of your prescriptions throughout the year. A plan with a lower monthly premium may not necessarily be the most affordable option if your medications have higher copayments or are not included on its formulary.
Prescription drug coverage can be an important part of protecting yourself against unexpected medication expenses. Reviewing your coverage annually is also important because plan premiums, formularies, pharmacy networks, and coverage details can change from year to year.
Frequently Asked Questions About Medicare Part D
Is Medicare Part D included automatically with Medicare?
No. Original Medicare does not include routine outpatient prescription drug coverage. You generally need to enroll in a standalone Part D plan or select a Medicare Advantage plan that includes prescription drug coverage.
Can I get Medicare Part D if I have Medicare Advantage?
You generally receive prescription drug coverage through your Medicare Advantage plan if it includes Part D. Most people enrolled in a Medicare Advantage plan with drug coverage should not enroll in a separate standalone Part D plan, as doing so may affect their Medicare Advantage enrollment.
What happens if I don't enroll in Medicare Part D when I'm first eligible?
If you go without creditable prescription drug coverage for 63 or more consecutive days after your Initial Enrollment Period, you may face a late enrollment penalty if you enroll later. Creditable coverage is prescription drug coverage expected to pay at least as much as standard Medicare Part D coverage.
Should I review my Part D plan every year?
Yes. Prescription drug plans can change their premiums, covered medications, pharmacy networks, and cost-sharing requirements annually. Reviewing your plan each year helps you determine whether it still meets your medication and budget needs.