Medicare Prescription Drug Coverage

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Most prescription drugs aren’t covered by Part A or B. But, as we all know, they can be very expensive, so Medicare Part D was enacted in 2006. Part D allowed private insurance companies to provide drug coverage to Medicare-eligible Americans.

You can get drug coverage from Part D in two ways:

Standalone Prescription Drug Plans (add this to your Medigap coverage), or
Medicare Advantage Prescription Drug Plans (MAPD)

How To Know If Your Medications Are Covered by a Medicare Part D Plan

Every Part D drug plan has a formulary, which is a fancy term for the complete list of all the drugs and vaccines the insurance plan covers. Check the formulary to see if your drugs are covered. You can usually check the formulary online or over the phone with the insurance company.

How Does Medicare Part D Drug Coverage Work?

Standalone Part D Prescription Drug Plans (PDP) are offered by private insurance companies. They help you pay for the cost of medications. You do not need to use the same insurance company for both your Medigap and PDP plan.

As mentioned earlier, each Part D drug plan has a specific list of covered medications. If a medication is not on the formulary, it will not be covered and you’ll pay full cost for it.

You can expect to pay these costs for standalone drug coverage:

Monthly premium
Annual deductible (many plans have no deductible, but the maximum is $445 for 2021)
Co-pays / co-insurance for each prescription filled during the year

If you don’t enroll in a Part D plan when you’re first eligible, you might have to pay a penalty when you enroll.

Do I Need to Enroll in a Part D Drug Plan?

Yes, unless you have “creditable coverage” from your employer or union, or if you have Medicare Advantage coverage, you will need to enroll if you have employer coverage, talk to your HR department to make sure that it meets the creditable coverage requirements.

When Can I Sign up for Medicare Part D?

You can sign up for a prescription drug plan when you first become eligible for Medicare, during your IEP. You’ll have a seven-month window to enroll in Part D, which includes:

3 months before the month you enter Medicare
The month you enroll in Medicare
3 months after the month you enroll in Medicare

Besides your initial enrollment period, you’ll have three other chances to add or change Part D coverage:

During the Annual Election Period (AEP, from October 15th to December 7th of every year)
During Special Election Periods that you qualify for, based on changes in your circumstances
During the Medicare Advantage Open Enrolment Period (MA-OEP, from January 1st to March 31st of each year, but only if you drop Medicare Advantage and return to Original Medicare)

You can get help from a licensed insurance agent, too. Reach out to one of our agents today to find a Part D plan that covers your needs.

Customers found they could possibly save an average of $782/year on their Rx drugs.

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