Prescription Drug plan
Medicare Prescription Drug Plan (Medicare Part D)

Original Medicare (Parts A and B) DOES NOT include a Prescription Drug Plan. In fact it does not cover prescription drugs. Medicare beneficiaries who want drug coverage have two options:

  1. Add a stand alone Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans.
  2. Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage. You get all of your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” You must have Part A and Part B to join a Medicare Advantage Plan.

Both Medicare Part D and Medicare Advantage plans are offered by private insurance companies approved by Medicare.

Who Can Get Medicare Part D?

Anyone who is eligible for Medicare is also eligible to get a Part D prescription drug plan. You must be enrolled in both Medicare Part A and Part B before you can get drug coverage through a Part D or Medicare Advantage plan.

What Does Medicare Part D Cover?

The federal government requires that certain, common types of drugs are covered by Medicare Part D. Each individual Part D or Medicare Advantage plan may choose which specific drugs of each type it will cover.  These may include brand-name and generic drugs.

It’s important to know which specific drugs are covered by the prescription drug plan you’re interested in.  You want to make sure that the medications you take are covered.

What Does Medicare Part D cost?

Most Part D plans charge a monthly premium. Other Part D costs may include an annual deductible and then co-pays or co-insurance each time you fill a prescription.  The specific amount you may pay differs from plan to plan.

Each Part D plan has a formulary or list of covered drugs.  Many formularies are tiered.  Drugs in lower tiers usually cost less than drugs in higher tiers. Your costs could be significant if you take a drug that’s not on your plan formulary.

Many plans have pharmacy networks.  Generally, you pay less for prescriptions filled at network pharmacies.  Some plans have mail-order pharmacy benefits that may offer additional savings.