Medicare Prescription Drugs Plans (Medicare Part D)
Understanding Your Coverage
What is Medicare Prescription Drug coverage (Medicare Part D)?
Medicare prescription drug coverage (Part D) is insurance provided by private companies that provide voluntary outpatient prescription drug coverage for people on Medicare. Part D became effective in 2006 and is administered through private plans that are approved by the federal government via CMS (Centers for Medicare and Medicaid Services).
Medicare prescription drug coverage (Part D) is available to everyone entitled to Medicare Part A and/or enrolled in Part B. The Medicare drug benefit should help reduce prescription drug costs and help protect against higher (catastrophic) costs in the future. When you get Medicare prescription drug coverage, you will pay some of the costs and Medicare will pay some of the costs. Your costs will vary depending on the plan you choose. You typically enroll for coverage for a calendar year.
Who is eligible for Medicare Part D?
Anyone who lives in the geographic service area and is entitled to Medicare Part A and/or enrolled in Medicare Part B is entitled to Medicare prescription drug coverage, regardless of income. No physical exams are required. Nobody can be denied for health reasons.
How do I get this coverage?
You’ll need to enroll in a Medicare Part D plan offered in your area. There are two types of prescription drug plans available:
- "Stand alone" Part D plans that cover only Part D prescription drugs
- Medicare Advantage Prescription Drug Plans (MAPD) plans, which cover medical and prescription drug costs.
What if I already have prescription drug coverage?
You can only be enrolled in one Medicare Part D plan each year. You should talk to your plan, benefits administrator or insurer before making any changes. You will be notified about any changes in your current coverage so you can decide if you should join a Medicare Part D plan or switch from your current Part D plan.
Will everyone get the same coverage?
No. While each plan must offer coverage that is at least as good as the "standard" Medicare Part D benefit, coverage and costs can vary.
You may receive assistance with your out-of-pocket costs if your income is limited, if you are in a state pharmacy assistance program, or you have employer or union-sponsored retirement coverage. Refer to the Financial Help section for more information.
Are all drug plans the same?
No. There could be differences in monthly premium, deductible, covered drugs, copay or coinsurance levels and the pharmacies that you can use. Some plans offer supplemental benefits, such as additional prescription drug coverage in the coverage gap. To determine which plan is best for you, compare plans in your area to learn what your benefits and estimated costs will be.