Medicare Prescription Drug Plans

Medicare Part D Coverage

Exploring Your Prescription Drug Coverage Options

Medicare Part D is an essential component of the Medicare program, providing beneficiaries with coverage for prescription medications. This section of our website is dedicated to helping you understand what Medicare Part D covers, how to determine if it’s right for you, and how to enroll.

What is Medicare Part D?

Medicare Part D is the prescription drug coverage component of Medicare. It’s offered by Medicare-approved private insurers and helps cover the cost of prescription medications, potentially lowering your drug expenses and protecting against higher costs in the future.

Key Features of Medicare Part D

Wide Range of Medications

Part D plans typically cover a wide range of prescription drugs that beneficiaries may need, including most drugs in certain protected classes.

Formulary

Each Part D plan has its own list of covered drugs, known as a formulary, which is divided into tiers based on the cost of the drugs. The tier affects your out-of-pocket costs for each medication.

Co-Pays and Deductibles

Depending on your plan, you may have a deductible and co-pays or coinsurance for your medications.

Coverage Gap (“Donut Hole”)

There is a temporary limit on what the drug plan will cover for drugs. Not everyone will enter this coverage gap; it depends on your plan and your drug costs.

Catastrophic Coverage

Once you spend up to a certain limit out-of-pocket, you’re out of the coverage gap and automatically get “catastrophic coverage,” significantly lowering your drug costs for the remainder of the year.

Eligibility and Enrollment

  • You’re eligible for Medicare Part D if you have Medicare Part A and/or Part B.
  • You can enroll in a Part D plan when you first become eligible for Medicare and during the Annual Enrollment Period (October 15 to December 7).
  • If you don’t enroll when you’re first eligible, you may pay a late enrollment penalty.
 
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