Medicare Prescription Drug Plans

What Is Medicare Part D?

Medicare Part D provides all Medicare recipients with prescription drug coverage. Part D can lower the amount you pay out-of-pocket for medication at the pharmacy.

Enrolling in Medicare Part D

There are two methods by which you can enroll in Medicare Part D.

Medicare Prescription Drug Plans (PDP)

Through Prescription Drug Plans, prescription drug coverage can be added to Original Medicare, as well as certain Medicare Cost Plans. In order to join a PDP, you must first have Medicare Part A and / or Medicare Part B. They are frequently paired with Medigap policies.

Medicare Advantage Plans

Many Medicare Advantage Plans and other Medicare health plans offer prescription drug coverage (Part D), in addition to Part A and Part B. Enrollment in both Part A and Part B is necessary to qualify for a Medicare Advantage Plan. If your Medicare Advantage Plan (Part C) does not include Part D, you cannot add a Prescription Drug Plan to it. Plans that do not include Part D are usually intended for use by clients who already have alternative prescription drug coverage, such as VA benefits or another employer prescription plan.

Choosing the Right Drug Plan

Drugs are divided into five tiers based on their cost, from preferred generic to specialty. Looking at the different drug tiers can help you estimate the cost of your medication, though fees can vary between plans.

In general, cost estimates per month are as follows:

Tier 1: Preferred Generic ($3)

Tier 2: Generic ($10 – $15)

Tier 3: Preferred Brand ($35 – $47)

Tier 4: Non-preferred Drug (45% of drug cost)

Tier 5: Specialty (33% of retail cost)

The cost of your drug plan will depend not only on what tiers your prescription drugs are in, but on many other factors, such as the plan’s monthly premiums, your income level, and which pharmacy you use.

Whether or not you currently need prescription drugs, enrolling in a prescription drug plan when you become eligible can save you money down the road. If you decide to join Medicare Part D after the period in which you first become eligible, you will likely be charged with a late enrollment penalty fee.