What is a Medicare Part D Plan?

Medicare Part D plans are also known as Medicare prescription drug plans because they help cover the cost of prescription drugs that are not covered in Parts A and B. Medicare Part D eligibility begins the month of your birthday and ends three months afterward. You must pay for Part B in order to be eligible. Most Medicare Advantage plans include prescription drug coverage.

How Much Does Medicare Part D Cost?

The Medicare Part D cost depends on a few things, including when you enroll. If you do not sign up when you become eligible, the premium price may go up for later enrollment or you will be required to pay a penalty set by Medicare. Coverage for Medicare D plans is not automatic and you must enroll during your initial eligibility period.

Different plans offer different Medicare drug coverage based on the plan’s specific Medicare Part D plan formulary. The formulary is a list of drugs the Medicare drug plans cover in different pricing tiers. The federal government sets the pricing guidelines for prescription drug costs. Most plans cover the same drugs, but the monthly premiums are set in October and vary by plan. Depending on the plan, there will be levels of cost sharing until you hit the set spending threshold in one year.

Medicare Prescription Drug Plans

Medicare prescription drug coverage is performed in stages under Part D Medicare. Plans with a deductible require you to pay the total amount of your drug costs until the deductible is reached. Then you go through the drug coverage stages. Each plan’s pricing for the coverage stages are different, but the stages are initial coverage, coverage gap, and catastrophic coverage through the end of the year. During the coverage gap, the average amount that is paid is around:

• 65% of generic drug price
• 45% of brand-name drug price

It is important to make sure your prescription drugs are covered under the plan you choose. The Medicare prescription drug benefit will change each year along with the list of drugs covered. Depending on the different Medicare Part D drug plans, choice of pharmacies may be limited by area. Some plans offer nationwide pharmacy coverage or mail order service for prescription drugs. You are free to change your Medicare Part D coverage yearly during open enrollment from October 15 through December 7.

Medicare Part D Coverage Providers

Take a look at the current Medicare providers we work with to compare Medicare Part D plans and find the best one for your needs.