Medicare Part D Prescription

Your prescriptions should
lead the plan comparisons.

The Basics

What is Medicare Part D?

Medicare offers prescription drug coverage to people with Medicare through Medicare Part D. Prescription drug coverage can help with the cost of many commonly prescribed medications, but each plan has its own premiums, costs, covered medications, and rules.

If you decide not to enroll in Medicare prescription drug coverage when you are first eligible and you do not have other creditable prescription drug coverage, you may have to pay a late enrollment penalty if you enroll in Part D later. The penalty generally applies unless you qualify for an exception, such as having other creditable coverage or qualifying for Extra Help with prescription drug costs.

To receive Medicare prescription drug coverage, you must enroll in a Medicare-approved prescription drug plan offered by a private insurance company or other private company approved by Medicare.

Helpful tips for comparing Medicare Part D prescription drug plans
Start with the prescriptions you take. Drug coverage, pharmacy networks and costs can vary from one Medicare plan to another.

Your coverage options

2 Ways to Get Medicare Prescription Drug Coverage

Medicare Prescription Drug Plan (Part D)

A stand-alone Medicare Prescription Drug Plan, sometimes called a PDP, adds prescription drug coverage to Original Medicare. Part D coverage may also be available with certain Medicare Cost Plans, Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans.

With a stand-alone Part D plan, you generally keep your Original Medicare Part A and Part B coverage while receiving your prescription drug coverage through a separate private insurance plan.

Medicare Advantage Plan with Prescription Drug Coverage (Part C)

Many Medicare Advantage Plans, such as HMO and PPO plans, include prescription drug coverage as part of the plan. These plans are often referred to as Medicare Advantage Prescription Drug plans (MA-PDs).

With an MA-PD plan, your Medicare Part A and Part B benefits and your Medicare prescription drug coverage are generally provided through the same Medicare Advantage plan.

You must have Medicare Part A and Part B to enroll in a Medicare Advantage Plan.

What Prescription Drugs Do Plans Cover?

Each Medicare prescription drug plan has its own list of covered medications, called a formulary. A formulary identifies the prescription drugs that the plan covers and may include brand-name and generic medications.

Plans may place covered medications into different tiers. Each tier can have a different cost-sharing amount. In general, medications placed on lower tiers may cost less than medications on higher tiers.

Because formularies can differ from one plan to another, it is important to check whether your medications are covered before choosing a plan. You should also review the plan's pharmacy network, copayments, coinsurance, deductible, and other coverage rules.

What If Your Medication Is on a Higher Tier?

In some situations, your doctor or other prescriber may determine that you need a particular medication instead of a similar medication on a lower tier. You or your prescriber may be able to request an exception from the plan.

An exception request asks the plan to provide coverage under different terms than normally apply. Approval is not guaranteed, and the plan will review the request according to its rules and Medicare requirements.

Choosing Prescription Drug Coverage

When comparing Medicare prescription drug options, consider more than just the monthly premium. Your total prescription drug costs can depend on the medications you take, the plan's formulary, pharmacy network, deductible, copayments or coinsurance, and other plan rules.

A licensed insurance agent can help you review available Medicare prescription drug options and understand how different plans may cover your medications.

Plan availability, premiums, deductibles, covered drugs, pharmacy networks, copayments, coinsurance, and other costs or coverage rules vary by plan and service area. Formulary information and coverage can change. Always review the plan's current materials for complete details.
Your Plan Review

Questions the
comparison
should answer.

We’ll use your prescription list to make the review personal.

Are all my medications on the formulary?

What will each prescription cost at my preferred pharmacy?

Do any drugs require prior authorization or step therapy?

Could Extra Help reduce my prescription costs?

Ready when you are

Let’s make your next Medicare decision clearer.

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