RX Prescription Advantage
What is Medicare Part D Coverage?
Quick Guide to Medicare Part D
Medicare Part D is prescription drug coverage that is sold through private insurance companies with Medicare’s approval. In order to enroll in Part D, you must already be enrolled in Medicare Part A or Part B. Most Part D plans require a monthly premium payment for this coverage, but Part D plans may help you to lower the out-of-pocket costs for prescription drugs.
You can get Part D coverage one of two ways: either as a stand alone Prescription Drug Plan (5PDP) that works with your Original Medicare coverage, or through a Medicare Advantage Prescription Drug plan (5MA-PD), which is a private plan that combines health benefits with prescription drug coverage.
Every Medicare Part D plan has its own formulary, or documented list of covered prescriptions. The formulary places these drugs into different tiers, and drugs in each tier are likely to require different coinsurance or copayment amounts. Generally, drugs in the lowest tier are generic and have the lowest costs. Higher tiered drugs are usually brand-name and are likely to be cost more.
You can shop around to find the Part D plan the works best for you in terms of both coverage and cost.
If you decide not to enroll in a drug plan when you are first eligible, you may have to pay a penalty if you join later.
Medicare has neither reviewed nor endorsed this information.