What is a PDP (Prescription Drug Plan)?Posted by Medicare Made Clear
Medicare Part D prescription drug plans are also known as PDPs. These are standalone plans that can be purchased through private insurance companies. PDPs provide coverage for prescription drugs and medications, and may also cover some vaccines too.
Original Medicare (Parts A & B) and Medicare supplement insurance plans don’t provide prescription drug coverage. If you have Original Medicare and need prescription drug coverage, you’ll want to sign up for a Part D prescription drug plan.
What Does a PDP Cover?
Plans will vary by location and provider in terms of costs and specific drugs covered. Each plan will have a list of specific drugs it covers, known as a formulary, but all PDPs are required by law to cover certain common types of drugs.
Medicare Part D plans are required to cover the Shingles vaccine, but they may also cover other vaccines such as Tdap, for the flu and pneumonia. What vaccines are covered outside of Shingles will depend on your plan. You can learn more about Medicare and vaccine coverage in this PDF from the Center for Medicaid and Medicare Services (CMS).
Enrolling in a Part D Prescription Drug Plan
To get a PDP plan, you will have to enroll directly with the plan provider. Unless you qualify for a Special Enrollment Period due to working past 65, it’s best to enroll in Part D when you’re first eligible for Medicare. This will be during your Initial Enrollment Period, which you can learn about and get key information on in the Medicare Enrollment & Eligibility Resources hub here.
If you do not enroll in Part D when first eligible and do not qualify for a Special Enrollment Period, you could face financial penalties. You can learn about Part D penalties in this video.
Can I Combine a PDP Plan with Other Medicare Coverage?
Yes, you can combine Medicare coverage parts with a Part D plan. A standalone PDP can work with Original Medicare (Parts A & B), Medigap plans, and certain types of Medicare Advantage plans such as Medicare Medical Savings Account plans or Private Fee-for-Service plans.
You can have a standalone prescription drug plan with certain types of Medicare Advantage plans so long as the plan:
- Can’t offer coverage for prescription drugs
- Chooses not to offer coverage for prescription drugs
If after the first time you enroll you decide to change your PDP, you can do so each year during the Medicare Annual Enrollment Period, which begins October 15 and ends December 7.
Part D prescription drug coverage is important to ensuring you can get all the medications you need to live your healthiest life. For more information on Part D click here.
For more information about Medicare, 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.
Tags: medicare advantage, Medicare Part D, Medigap