MEDICARE PRESCRIPTION DRUG PLANS

Medicare Part D prescription drug coverage is designed to help you cover the rising cost of your medications. It’s 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 don’t enroll in Part D as soon as you’re eligible, you may pay a late-enrollment penalty if you join a plan later. After your initial enrollment, you can change Part D plans each year between October 15th and December 7th. If you find that changing drug plans will lower your costs, the coverage on your new drug plan will begin on January 1st of the following year.

If you’re enrolled in Original Medicare only, or Original Medicare and a Medicare Supplement plan, you must get prescription drug coverage through a standalone Medicare Part D Prescription Drug Plan (PDP). Many Medicare Advantage plans include drug benefits (These are known as Medicare Advantage Prescription Drug plans); however, certain Medicare Advantage plans do not include Part D coverage, so you would need a standalone Part D plan.

There are typically 20+ standalone Part D drug plans offered in every zip code. Different insurers offer various types of plans, so your monthly plan premium and out-of-pocket expenses for prescription drugs will vary from plan to plan based on your particular prescriptions.

After a Medicare Part D plan has paid a certain amount for prescription drugs, you may have to pay all costs yourself up to a yearly limit. This temporary limit on what your Part D plan will pay for covered drugs is the coverage gap (also called the “donut hole”) and applies to both Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug (MAPD) plans.