Prescription Drug Plan (Part D)
Medicare Part D prescription drug coverage, often referred to as Part D, is provided and coordinated by Medicare-approved private insurance companies. Any beneficiary who is eligible for Original Medicare, Part A and/or Part B, and permanently resides in the service area of a Medicare Prescription Drug Plan, can sign-up for Medicare Part D. Medicare Part D coverage is optional, but if you decide not to get Medicare drug coverage when you’re first eligible, you’ll likely pay a late enrollment penalty if you join later, unless one of these applies:
- You have other Creditable prescription drug coverage
- You get Extra Help
Part D is provided only through private insurance companies that have contracts with the federal government—it is never provided directly by the government (unlike Original Medicare). If you have Medicare Part C, you can get prescription drug benefits by enrolling in a Medicare Advantage plan that includes this coverage. Also known as Medicare Advantage Prescription Drug plans, these plans give you the option to get your Medicare health and prescription drug benefits covered under a single plan.
Every Medicare Prescription Drug Plan has a formulary — that is, a list of covered drugs. The formularies vary among plans. The formulary may change at any time. You will receive notice from your plan when necessary.
Keep in mind that if you fill a prescription that is not in your plan’s formulary, then you may be responsible for the full retail cost of the drug.
The design for a Part D plan includes:
- An annual deductible
- The Initial Coverage Limit
- The Coverage Gap – known as the “Donut Hole”
- Catastrophic Coverage
Part D drugs fall into tiers that depend on the cost of a drug. A co-pay amount or percentage is assigned to each tier. A plan may have 4 or more tiers such as:
- Tier 1 – Generic drugs
- Tier 2 – Preferred Name Brand drugs
- Tier 3 – Non-Preferred Name Brand drugs
- Tier 4 – Specialty drugs
We’re Here to Help
As each plan is different, there are many things to consider when choosing a drug plan that is right for you, the most important being “are your drugs on the formulary?” For assistance in finding the right plan for your prescription needs, call 800-535-3304 to speak with a Medicare insurance specialist.
Who can Buy a Part D policy?
What is not covered?
Prescription drugs used for the below conditions may be covered if they are being prescribed to treat other conditions. For example, a medicine for the relief of cold symptoms may be covered by Part D if prescribed to treat something other than a cold—such as shortness of breath from severe asthma—as long as it is approved by the U.S. Food and Drug Administration (FDA) for such treatment. See article – Drugs excluded from Part D coverage