Prescription Drug Coverage
Medicare Part D Plans
Medicare Part D helps with the cost of prescription drugs.
Individuals must be enrolled in Part B to be eligible for a Part D plan. They can get drug coverage with a standalone Part D plan or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies approved by Medicare. Choices vary depending on location. Coverage and costs beyond the standards set by Medicare vary from plan to plan. Some plans have pharmacy networks and mail order pharmacies that offer discounted prices.
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Medicare Part D Plans Cover: |
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Types of drugs most commonly prescribed for Medicare beneficiaries as determined by federal standards |
Specific brand name and generic drugs on the plan formulary, or list of drugs |
Stages of Part D Coverage
Part D coverage is broken into four stages. Individuals pay a share of the cost for their drugs in each stage. The stages progress based on how much they and their plan pay, up to set limits. The cycle restarts at the beginning of each year.
Annual Deductible
Insured pays 100% of the cost up to the plan deductible amount.
Initial Coverage
Insured pays copay or coinsurance up to a set limit.
Coverage Gap (Donut Hole)
Insured pays percentage of cost up to an out-of-pocket limit.
Catastrophic Coverage
Insured pays reduced copay for the rest of the year.
Options for Part D Coverage
Medicare isn’t one-size-fits-all. Parts and plans can be combined to customize coverage. There are 7 possible combinations.
ORIGINAL MEDICARE OPTIONS
Original Medicare (Parts A & B) plus a standalone Part D plan
MEDICARE ADVANTAGE OPTIONS
A Medicare Advantage (Part C) plan without drug coverage plus a standalone Part D plan; only works with certain Medicare Advantage plan types
MEDICARE SUPPLEMENT OPTIONS
Original Medicare (Parts A & B) plus a standalone Part D plan plus a Medicare supplement plan
