| Tue, Jun 28, 2016 @ 09:00 AM

Medicare Part D: The Basics

Posted by Medicare Made Clear

medicare-part-dOriginal Medicare (Parts A and B) does not cover prescription drugs. Medicare beneficiaries who want drug coverage have two options:

  • Add a standalone Medicare Part D prescription drug plan to Original Medicare, or
  • Join a Medicare Advantage (Part C) plan that includes drug coverage.

Both Medicare Part D and Medicare Advantage plans are offered by private insurance companies approved by Medicare.

Who can get Medicare Part D?

Anyone who is eligible for Medicare is also eligible to get Part D prescription drug coverage. You must be enrolled in both Medicare Part A and Part B before you can get drug coverage through a Part D or Medicare Advantage plan.

What does Medicare Part D cover?

The federal government requires that certain, common types of drugs are covered by Medicare Part D. Each individual Part D or Medicare Advantage plan may choose which specific drugs of each type it will cover. These may include brand-name and generic drugs.

It’s important to know which specific drugs are covered by the plans you’re interested in. You want to make sure that the medications you take are covered.

What does Medicare Part D cost?

Most Part D plans charge a monthly premium. Other Part D costs may include an annual deductible and then co-pays or co-insurance each time you fill a prescription. The specific amount you may pay differs from plan to plan.

Each Part D plan has a formulary or list of covered drugs. Many formularies are tiered. Drugs in lower tiers usually cost less than drugs in higher tiers. Your costs could be significant if you take a drug that’s not on your plan formulary.

Many plans have pharmacy networks. Generally, you pay less for prescriptions filled at network pharmacies. Some plans have mail-order pharmacy benefits that may offer additional savings.

How do I join a Medicare Part D or Medicare Advantage plan?

You may choose to enroll in a standalone Part D plan or a Medicare Advantage plan with drug coverage after you complete your initial enrollment in both Part A and Part B. You may also join a plan or change plans during Medicare Open Enrollment, which happens every year from October 15 through December 7.

You may want to sign up for Part D as soon as you become eligible. You could be charged a premium penalty if you delay enrollment, unless you qualify for a Special Enrollment Period.

You can find out about plans offered where you live using Medicare’s plan finder tool. Just enter your zip code and the plan finder will show you a list of available plans.

You may enroll in a plan at Medicare.gov or with the plan directly, once you are comfortable with your plan choice.

Conclusion

You may want to consider adding Part D to your Medicare coverage even if you don’t take many medications. Your health needs may change in the future, and prescription drug coverage could cost you more if you don’t enroll when you’re first eligible.

It’s important to look for Medicare coverage that may fit with your health care needs and budget. Your State Health Insurance Assistance Program (SHIP) offers free counseling services, if you need help.

Related Content

Medicare Prescription Drug Plans (Part D) (video)

What should I look for in a Medicare prescription drug plan?

Words with Peter: Tiered Formulary (video)

For more information, explore MedicareMadeClear.com or contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048.

 

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