Medicare
Part D RX

Medicare's Prescription Drug Program

What is Medicare Part D?

Medicare Part D Prescription Drug plans are part of the government’s Medicare program, but they are offered and managed through approved private insurance companies. These plans help lower the cost of prescription drugs that can prevent complications from disease and help keep you healthy.

If you are entitled to Original Medicare Part A and/or enrolled in Medicare Part B, then you are eligible to enroll in a Part D plan. There are certain times of year that you must enroll unless you have a special circumstance.

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What are the pros and cons of Part D Prescription Drug plans?

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Part D plans help protect against high-cost prescription drugs by offering various levels of cost coverage for different “tiers” of drugs

Low premiums help make these plans affordable

Part D plans offer you choices in cost and benefit levels depending on your needs and other coverage you may have.

Works with Medicare Part A and Part B (Original Medicare), or may be included in a Medicare Advantage plan (Part C)

Plans differ from insurer to insurer: Part D plans must offer a minimum amount of coverage per Medicare, but otherwise plans can differ. This means you need to shop around and educate yourself on what each plan covers.

Need to anticipate your prescription drug needs for the year: Part D plans differ in the types of drugs they cover. Knowing your medical situation can help you select a plan that is right for you and covers the prescription drugs you expect to need.

Not all drugs are covered: Each plan has its own drug list (formulary), level of cost coverage, and monthly premium.

Fail to enroll in a Part D plan when you are eligible and you may end up paying a late enrollment penalty. For every month you delay enrolling, Medicare will charge you a small fee, which is added to your monthly premium.

How does Medicare drug coverage work?

A typical Part D plan has 3 phases and works like this:
  • Deductible and Initial Coverage: The “typical” plan has an annual deductible. After you have paid costs equal to the deductible amount, then you have Initial Coverage. In this phase, you will only pay a copay or coinsurance on covered prescription drugs until you reach the Initial Coverage Limit, which starts the Coverage Gap.
  • Coverage Gap: Also known as the “donut hole.” Here you pay a discounted amount for brand and generic drugs. Once your combined drug costs reach the upper level of the Coverage Gap, you move to Catastrophic Coverage. In 2020 the “donut hole’ was reduced significantly. 
  • Catastrophic Coverage: You will pay a small amount for medications, typically not more than 5% of the cost. The plan pays most of the cost.

There are 2 ways to get Medicare drug coverage:

  1. Medicare Part D plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee-for-Service plans, and Medical Savings Account plans. You must have Part A and/or Part B to join a separate Medicare drug plan.
  2. Medicare Advantage Plans or other Medicare health plans with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.