Medicare Part D
Prescription Drug Plans, also called PDPs or Part D plans, help cover the cost of prescription medications through private insurance companies.
PRESCRIPTION DRUG PLANS
Medicare Part D coverage for prescription medications.
A Prescription Drug Plan, also called Medicare Part D, is offered through private insurance companies and helps cover the cost of prescription drugs.
Original Medicare generally does not cover most prescription medications outside of the hospital. Because medication costs and plan rules can change, reviewing your Part D options can make a real difference.
HOW IT WORKS
What is a Prescription Drug Plan?
Part D is an optional Medicare program regulated by Medicare and offered through private insurance companies. Plans follow Medicare guidelines but still differ in meaningful ways.
Optional, but important
You do not have to enroll in a PDP, but going without creditable drug coverage when eligible can lead to a late enrollment penalty.
Standalone or bundled
Part D coverage may be purchased as a standalone prescription drug plan or included inside many Medicare Advantage plans.
Review every year
Each plan has its own covered drug list, pharmacy network, copays, and deductible, so it is worth comparing your options annually.
PART D BASICS
Your prescriptions should drive the comparison.
You are generally eligible for a Prescription Drug Plan when you have Medicare Part A or Medicare Part A and Part B. Some people are under 65 with a qualifying disability, some are newly eligible at 65, and others review Part D after leaving creditable prescription drug coverage.
If you choose not to enroll when eligible and do not have other creditable coverage, such as coverage through group insurance, Indian Health Services, Veterans Affairs, or another source, you may face a penalty for the time you went without coverage.
WHAT WE REVIEW
Bring your actual medication list.
Part D plans are not all the same. A plan that works well for one person may not be a good fit for another because each plan has its own pharmacy network, covered drug list, copays, and deductible.
- Your current prescription medication list
- Dosage, quantity, and how often each medication is filled
- Preferred pharmacies and mail-order options
- Covered drug list and formulary tiers
- Monthly premium, deductible, and expected copays
- Whether your coverage is standalone or built into Medicare Advantage
ANNUAL REVIEW
Compare your choices each year.
Your medications, pharmacies, and plan details can change. It is important to compare available options when you first become eligible for Medicare and each year after that.