Part D is a federally created program to help you lower the cost of your retail prescription drugs. Unlike Medicare Part A & B, you will not enroll in Part D through the Social Security office. Instead, you will select one of the Part D plans available in your county from private insurance carriers. By signing up for that plan, you will have enrolled in Part D.
Medicare drug plans are optional. You’ll have a monthly premium that you will pay to the insurance carrier. In return, they give you significantly lower copays on your medicines than you would pay if you had no Part D insurance.
Medicare prescription drug coverage is an optional benefit offered to everyone who has Medicare. This page explains how to get prescription drug coverage and offers tips for making the right choices for you.
If you decide NOT to get Medicare drug coverage when you’re first eligible, you’ll likely pay a late enrollment penalty if you join later, unless one of these applies:
- You have other creditable prescription drug coverage
- You get Extra Help
Generally, you’ll pay this penalty for as long as you have Medicare prescription drug coverage.
To get Medicare drug coverage, you must join a Medicare plan that offers prescription drug coverage. Each plan can vary in cost and drugs covered.
There are 2 ways to get prescription drug coverage
- 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.
- 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.
See if any of these apply to you:
I take specific drugs: We can go over all the drug plans that include your prescription drugs on their Formulary (a list of prescription drugs covered by a drug plan). Then find the plan that will cover all your medication at the lowest cost.
I want extra protection from high prescription drug costs: We can go over the drug plans offering coverage in the coverage gap, and then check with those plans to make sure they cover your drugs in the gap.
I want my drug expenses to be balanced throughout the year: We can look at the drug plans with No or Low Deductible, or with additional coverage in the coverage gap.
I take a lot of generic prescriptions: We can look at drug plans with “tiers” that charge you nothing or low co-payments for generic prescriptions.
I don’t have many drug costs now, but I want coverage for peace of mind and to avoid future penalties: We can look at the drug plans with a low to sometimes $0 monthly premium for drug coverage. If you
need prescription drugs in the future, all plans still must cover most drugs used by people with Medicare.
I like the extra benefits and lower costs available by getting my health care and prescription drug coverage from one plan, and I’m willing to pick a drug plan with restrictions on what doctors, hospitals, and other health care providers I can use: We can go over all the Medicare Advantage Plans with prescription drug coverage that are available in your county.
Joining a Medicare drug plan may affect your Medicare Advantage Plan
Your Medicare Advantage Plan (Part C) will disenroll you and you’ll go back to Original Medicare if both of these apply:
- Your Medicare Advantage Plan includes prescription drug coverage.
- You join a Medicare Prescription Drug Plan (Part D)
There are rules for when you can enroll and dis-enroll from these drug plans, so be sure to Contact Us for more details about how your drug coverage under Medicare will work.