PART D DRUG PLAN

Medicare Part D helps with the cost of prescription drugs.  You can get drug coverage with a standalone Part D plan or as part of a Medicare Advantage plan also known as Part C.  Typically, plans will have a network of pharmacies and many plans offer mail order.  Often discounts are provided for utilizing preferred network pharmacies.  These discounts vary based on the specific plan and the insurance company offering the plan.  Plans are offered by private insurance companies approved by Medicare.  Your plan choices vary based on where you live.  Coverage and costs beyond standards set by Medicare vary from plan to plan.   

ELIGIBILITY You must be enrolled in Medicare Part A or Part B to be eligible for a Part D Plan

MUST KNOW

You must enroll when first eligible for Part D coverage otherwise you are subject to a Late Enrollment Penalty – this penalty is charged every month for as long as you have Part D coverage

COVERAGE STAGES

Part D has four stages.  You pay a share of the cost for your drugs in each stage up to a limit (established by the government each calendar year).  You may not reach all stages.  The cycle resets at the beginning of each calendar year.

PART D PLANS INCLUDE
  • Types of drugs most commonly prescribed according to federal standards

  • Specific brand name and generic drugs are listed in the plan’s formulary or drug list

  • Commercially available vaccines not covered by Medicare Part B

COVERAGE STAGES

Annual Deductible – some plans have a deductible you pay 100% of the costs for drugs that are subject to your plan’s deductible

Initial Coverage – your copays or coinsurance as outlined by your plan up to a set limit

Coverage gap or donut hole – you pay a percentage of the cost up to the out-of-pocket limit

Catastrophic – you pay reduced copays for the remainder of the calendar year

Compare Plans and/or Enroll
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