Medicare Prescription Drug (Part D)

Did you know that original Medicare Parts A and B don’t include prescription drug coverage?

A Medicare Prescription Drug (Part D) plan can help cover the costs of your medication. RX plans, offered through Part D in the private market can help you save money on your prescription drugs and give you peace of mind—even if your health changes. Plans include commonly used generic and brand name prescription drugs, but each plan has slightly different coverage and drug lists.

Medicare Part D is prescription drug coverage. It’s optional, but if you don’t enroll for this coverage when you’re first eligible for Medicare, you might face a late-enrollment penalty when and if you eventually decide to enroll.

Any beneficiary who is eligible for Original Medicare, Part A and/or Part B can sign-up for a stand-alone Medicare Part D prescription drug plan. If you’d prefer a Medicare Advantage prescription drug plan, you need to have both Part A and Part B.

Remember you must live within the plan’s service area.

Prescription Drug Coverage Options

Prescription drugs are not covered by Original Medicare. Once you’ve enrolled in Medicare, there are two main ways to get prescription drug coverage:

Medicare Part D Plans-You can purchase a standalone Medicare Prescription Drug (Part D) plan to help pay for your prescription drug costs if you have Original Medicare and/or a Medicare Supplement insurance plan.

Medicare Advantage Part C Plans-Most Medicare Advantage (Part C) plans include prescription drug coverage. And all Special Needs Plans, a type of Medicare Advantage plan, will include prescription drug coverage.

Please Remember: Medicare Advantage plans and Medicare Prescription Drug plans cover a certain set of prescription drugs, so be sure to check each plan’s drug list (formulary) to see if the prescription drugs you take will be covered.

Some things to keep in mind

• If the plan has an annual deductible, you generally pay the full amount of your prescription drug purchases until the deductible is met.
• After you satisfy the annual deductible, you will pay a share of the costs according to the terms of your plan. Your share, which you typically pay to the pharmacy at the time of pickup, could be a flat amount (copayment) or a percentage of the total amount (coinsurance).
• Once you have paid a certain annual maximum amount out of your own pocket for covered prescription drugs, you automatically get “catastrophic coverage.” This means for the rest of that particular year, you would only pay a small copayment or coinsurance amount for prescription drugs. Medicare Part D catastrophic coverage begins when you’ve spent $6,350 in 2020. This amount may change from year to year.
• Please always check with your doctor for medications and to see if you are on the lowest cost medication available to you. Some plans may vary.