Medicare Part D

• Admin
• 25 Jan 2025

Medicare Part D

If you’ve ever had to pay for a prescription out-of-pocket without insurance coverage, you may understand just how expensive medications can be. Medicare Part D is prescription drug coverage that helps pay for medications prescribed by your physician. If you are close to qualifying for Medicare—or you’re already enrolled but have had creditable drug coverage through an employer, union, or group that is ending—you may want to consider enrolling in Part D prescription drug coverage now.

Let’s discuss some basic information regarding Medicare Part D that may help you find the coverage you need:

Enrolling in Part D Prescription Drug Coverage
Medicare Part A and Part B do not help cover the costs of medications your doctor may prescribe for you to take at home. To get drug coverage, you must enroll in a Prescription Drug Plan (PDP) or a Medicare Advantage (MA) plan that includes prescription drug coverage.

If you have Original Medicare (Part A and Part B), you can join a stand-alone PDP offered by private insurance companies. While these plans are required to offer minimum standard coverage, the costs, formularies, and benefits may vary from plan to plan.

Alternatively, you can enroll in a Medicare Advantage plan (MA-PD) that bundles Part A, Part B, and Part D together. MA-PDs often include extra benefits such as dental and vision care, wellness programs, and over-the-counter discounts—providing more convenience by combining your coverage under one plan.

Drug Formularies and Tiers
Each Part D plan has its own formulary—a list of covered drugs—that categorizes medications into pricing tiers. These tiers help determine how much you pay out-of-pocket:

• Tier 1: Generic drugs with the lowest copayments
• Tier 2: Preferred, brand-name drugs
• Tier 3: Non-preferred brand-name drugs
• Tier 4: Specialty drugs with the highest copayments

Plans are required to cover a broad range of commonly prescribed drugs, including medications in protected classes like those used to treat cancer or HIV/AIDS. It’s crucial to compare plan formularies to make sure the medications you need are covered and affordable.

Choosing the Right Plan
Be sure to review and compare your options carefully. If you take specific medications, ensure they’re included in the plan’s formulary and available at a pharmacy you use. Some plans may offer mail-order discounts or require you to use network pharmacies to get full coverage.

When Should You Enroll in Part D?
The ideal time to enroll in Part D is during your Initial Enrollment Period (IEP). If you delay enrollment and don’t have other creditable drug coverage, you may face a permanent late enrollment penalty that increases the longer you go without coverage.

Costs Under Part D
Monthly premiums vary by plan and may be higher if your income exceeds certain limits or if you enroll late. Plans typically have an annual deductible that must be met before coverage begins. For 2022, the deductible cannot exceed $480.

Your actual out-of-pocket costs will depend on the medications you take, the pharmacies you use, and your selected plan. Be sure to compare available plans using your current prescriptions to estimate costs and choose the best option in your area.