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Prescription Drug Plans - Part D

PDP - Part D, is an optional drug benefit coverage plan. The two common ways of getting coverage are through a separate Part D plan added to your Original Medicare, or through a Medicare Advantage Plan where the Prescription Drug Plan is included.


Prescription Drug Plans

If you maintain creditable drug coverage through your employer or another insurance plan, you are not required to enroll in a Part D Plan. After losing creditable coverage, you will have a two month Special Enrollment Period (SEP) in which to enroll in a Medicare Prescription Drug Part D plan without penalty. If you go without creditable drug coverage for over 63 days, you could be charged a penalty. A penalty of 1% of the average monthly premium, once you then enroll, will be charged for each month you delayed and was without creditable coverage.

What is Covered?

Original Medicare Part A and Part B coverage DO NOT include prescription drug coverage. When choosing any Prescription Drug Plan - Part D coverage, it's important to check the plan's Formulary (list of covered drugs) to be certain that the medications you're subscribed to are covered.


Guidelines for the type of drugs included in Medicare Part D plans are decided by the federal government. Each Medicare Part D plans decide which drugs it will cover and the cost its members will pay. Copays are based on Tiers, numbered 1-5 and the out of pocket costs can vary from plan-to-plan. Some also have an annual prescription deductible that must be met and most plans have out-of-pocket maximums for copays and coinsurance during various coverage stages. 

Where Do I Get a Plan?

Medicare Part D Plans are available to individuals eligible for Original Medicare and are prided by private insurance companies contracted with Medicare. It's important to consult with a licensed authorized enrollment representative to help you determine a plan that best fits your needs. Often, those covered under Original Medicare alone will also need a Medicare Supplement Plan (Medi-gap) in addition to the Prescription Drug Plan. 


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