Medicare Prescription Drug (Part D) Coverage

Frequently Asked Questions

Medicare prescription drug coverage (Part D) is insurance provided by private companies that provide prescription drug coverage for people on Medicare. Part D became effective in 2006 and is administered through private plans that are approved by the U.S. Federal Government through CMS (Centers for Medicare and Medicaid Services ).

Medicare prescription drug coverage (Part D) is available for purchase 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. Once you have 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.

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.

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.

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.

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. If you have limited income, please refer to the Extra Help section for more information.

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.