What is Medicare Part D?

What it covers: Prescription Drugs

Medicare Part D provides prescription drug coverage that is supplemental to your Medicare Part A and Part B plans.

Medicare Part D plans are pre-approved private insurance policies that meet Medicare requirements. To be eligible for Medicare Part D, you must be actively enrolled in at least Medicare Part A, and usually in both Part A and Part B. This prescription drug benefit under Part D is then added to your current Medicare Part A and B plan.

Medicare Part C plans, also called Medicare Advantage plans, usually (but not always) include prescription drug coverage and thus don’t typically require an additional purchase of a Part D plan.

Compared to Original Medicare (Parts A and B)

Original Medicare doesn’t cover most of your medications. Part A covers drugs you get as a hospital inpatient only. Part B covers drugs you get as an outpatient, but in very limited cases, like infusion drugs.

The drugs that are covered by a Medicare Part D plan and their pricing are listed in the plan’s formulary, which you can request to see. Plans can change the drugs on their formulary during the course of the year as long as they give 60 days notice.

Medicare does not require that all drugs be covered. As long as the plan’s formulary and benefit structure are not designed to discourage enrollment by certain Medicare beneficiaries, they are legal.

Medicare Part D coverage excludes drugs not approved by the Food and Drug Administration, those prescribed for off-label use, drugs not available by prescription for purchase in the United States, and drugs which are covered under Parts A or B of Medicare. Part D coverage also excludes drugs for weight issues, fertility treatment, and purely cosmetic purposes. They also don’t cover vitamins and mineral supplements.

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