Understanding Medicare Prescription Drug Coverage (Part D)
Protect Yourself from High Prescription Drug Costs
Medicare Part D helps cover the cost of prescription medications. Prescription drug coverage may be available through a stand-alone Medicare Part D plan or included with many Medicare Advantage plans. Understanding how Part D works can help you evaluate your Medicare coverage and avoid unexpected prescription costs.
• Helps lower prescription drug costs
• Available through private insurance companies approved by Medicare
• Can be paired with Original Medicare or a Medicare Supplement plan
What Is Medicare Part D?
Medicare Part D is optional prescription drug coverage offered by private insurance companies approved by Medicare. These plans help cover many brand-name and generic medications available at your local pharmacy or through mail-order services.
Although Part D is optional, delaying enrollment when you’re first eligible may result in a late enrollment penalty if you don’t have other creditable prescription drug coverage.
What Does Medicare Part D Cover?
Depending on the plan you choose, Part D may cover:
• Generic prescription medications
• Brand-name medications
• Preferred pharmacies with lower costs
• Mail-order prescription services
• Many vaccines covered under Part D
Coverage varies by plan and by each plan’s drug formulary (list of covered medications).
What Isn’t Covered?
Generally, Medicare Part D does not cover:
• Most over-the-counter medications
• Vitamins and supplements
• Cosmetic medications
• Most medications used solely for weight loss
•Certain medications that Medicare excludes by law
Your Costs
Your costs may include:
Monthly Premium
Some Part D plans have low or even $0 monthly premiums, depending on where you live and the plan you choose.
Annual Deductible
Some plans require you to pay a deductible before coverage begins.
Copays and Coinsurance
Your out-of-pocket costs depend on:
• The medication
• Whether it’s generic or brand-name
• The pharmacy you use
Understanding Your Prescription Drug Coverage
Not all prescription drug plans are the same
When reviewing prescription drug coverage, important factors include:
• Your current medications
• The plan’s formulary
• Your preferred pharmacy
• Monthly premiums
• Deductibles
• Copays and coinsurance
Then change “Why Choose a Medicare Part D Plan?” to:
Why Prescription Drug Coverage Is Important
A Part D plan may be right for you if you:
• Take prescription medications regularly
• Want protection from high medication costs
• Want access to mail-order pharmacy services
• Want to avoid Medicare’s late enrollment penalty
• Want help managing long-term prescription expenses
When Should You Enroll?
The best time to enroll in a Medicare Part D plan is during your Initial Enrollment Period when you first become eligible for Medicare.
You may also enroll or make changes during:
• Annual Enrollment Period (October 15 – December 7)
• Certain Special Enrollment Periods if you qualify
Enrolling when you’re first eligible can help you avoid future late enrollment penalties.
Frequently Asked Questions
Do I need a Part D plan if I don’t take any medications?
Even if you don’t currently take prescription medications, it’s important to consider prescription drug coverage when you’re first eligible for Medicare. If you go without Part D or other creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period, you may have to pay a late enrollment penalty if you enroll in Part D later.
Can I change my prescription drug plan every year?
Yes. You can review and change your Medicare Part D plan during the Annual Enrollment Period (October 15 – December 7). Because premiums, covered medications, and pharmacy networks can change each year, it’s a good idea to review your plan annually.
What is a Medicare drug formulary?
A formulary is a list of prescription drugs covered by a Medicare Part D plan. Each plan has its own formulary, so it’s important to make sure your medications are included before you enroll.
Can I use any pharmacy?
Not always. Most Medicare Part D plans have a network of preferred and standard pharmacies. Using an in-network pharmacy generally helps you save money, while out-of-network pharmacies may cost more or may not be covered except in certain situations.
What happens if I don’t enroll when I’m first eligible?
If you don’t enroll in a Medicare Part D plan when you’re first eligible and you don’t have other creditable prescription drug coverage, you may have to pay a late enrollment penalty if you join a Part D plan later. The penalty may be added to your monthly premium for as long as you have Part D coverage.
Meet Your Independent Medicare Advisor
Derene Derricotte
Choosing a Medicare Part D plan doesn't have to be confusing. As an independent licensed Medicare agent, I'll help you compare plans, review your medications, check your preferred pharmacies, and find coverage that fits your needs and budget.
Choosing a Medicare plan doesn’t have to be confusing. I’m here to answer your questions, compare your Medicare options, and help you enroll with confidence.
Why Choose Derene Derricotte?
• Licensed Independent Medicare Insurance Agent
• Compare Medicare plans from multiple leading insurance companies
• Personalized one-on-one guidance
• Complimentary Medicare plan reviews
• Support before, during, and after enrollment
•Local, personalized service with access to nationwide carriers
Have questions about your Medicare prescription drug coverage?
Schedule a complimentary Medicare review to better understand how prescription drug coverage fits with your overall Medicare options.
Medicare Enrollment Timeline
3 months before your 65th birthday – Start exploring your options.
•Compare Medicare options.
•Check if your doctors participate.
•Review prescription drug coverage.
Month of your 65th birthday – Enroll
•Enroll if needed.
•Make sure your coverage begins on time.
3 months after – Initial Enrollment Period ends.
•Your Initial Enrollment Period ends.
•Missing this deadline may result in penalties.
FREE Medicare Guide
Turning 65? Download my FREE 4-page Medicare Guide to learn how Medicare works, avoid costly mistakes, and understand your coverage options before you enroll.
Common Medicare Mistakes to Avoid
•Missing your Initial Enrollment Period
•Assuming every Part D plan covers the same medications
•Not reviewing prescription drug coverage
•Keeping employer coverage without understanding Medicare rules
•Choosing a plan based only on premium
•Not checking if your doctors participate
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Medicare Disclaimer
We do not offer every plan available in your area. Any information we provide is limited to the plans we offer. Please contact Medicare.gov, 1-800-MEDICARE, or your local Medicare office to get information about all of your Medicare options.