Prescription Drug Plans · Part D
Part D drug coverage, explained simply.
Original Medicare covers very little in the way of prescriptions. Part D is the piece that fills that gap — and getting it right starts with your own prescription list.
What is Part D?
Part D is Medicare's prescription drug coverage. It is offered by private insurance companies that Medicare approves. You can get Part D in two ways: as a stand-alone drug plan that you add to Original Medicare (and, usually, to a Medicare Supplement plan), or as part of a Medicare Advantage plan that already includes drug coverage.
Every Part D plan has a formulary — a list of the drugs the plan covers. Plans also sort drugs into tiers, and what you pay depends on the tier your drug sits in and the plan's rules. That is why two people with the same prescriptions can pay very different amounts on different plans.
How Part D costs generally work
Part D plans have a monthly premium, and most have a deductible and copayments or coinsurance for each prescription. Your costs move through stages during the year as your drug spending adds up, and there is a limit on how much you pay out of pocket for covered drugs in a year. The exact amounts and rules change from year to year and vary by plan, so we go over the current details of any plan you are considering together — this page explains the structure, not the numbers.
The step most people skip: check your drugs
The single most useful thing you can do before choosing a Part D plan is to check your own prescription list against the plan's formulary. A plan can look good on paper and still be the wrong one if it does not cover a drug you take every day, or if it places that drug on a high tier.
- Write down every prescription you take, including the dose and how often you take it.
- Check whether each drug is on the plan's formulary — and on which tier.
- Ask about any rules on your drugs, such as prior authorization or step therapy.
- Consider your preferred pharmacy, including whether the plan offers a mail-order option.
- Re-check every year. Formularies change, and so can your prescriptions.
Bring your list when you call us. Checking prescriptions against plan formularies is one of the things we do with people every day.
Do not delay Part D without other drug coverage. If you go without creditable prescription drug coverage for a long stretch after you first become eligible, you may have to pay a late enrollment penalty if you sign up later — and that penalty can last as long as you have Part D. If you have drug coverage through an employer or another source, ask us whether it counts as creditable before you decide to wait.
Common questions
Do I need Part D if I take no prescriptions?
Many people in good health skip it — and then face a late enrollment penalty later if they need drug coverage. A low-cost Part D plan can be worth having just to avoid that penalty and to be covered if something changes. Call us and we can talk through whether that makes sense for you.
What if my drug is not on a plan's formulary?
You have options: a different plan may cover it, your doctor may be able to request an exception, or there may be a similar drug that is covered. This is worth sorting out before you enroll, not after. Bring your list and we will check it with you.
Can I change my Part D plan each year?
Yes. You can change Part D plans during the Annual Enrollment Period each fall (October 15 to December 7), and in certain other situations. Because formularies and your prescriptions change, it is worth reviewing your drug plan every fall. See our Enrollment Periods page.
Let us check your prescriptions with you.
Bring your list — we will go through the options together, in plain English.