Part D
Prescription Drug Plans (Part D)
Part D helps cover the cost of your prescription drugs. Understanding how these plans work is crucial to avoiding unexpected medication costs and lifelong penalties.
Important Distinction
Part D plans are standalone policies designed to work alongside Original Medicare and Medicare Supplement (Medigap) plans. If you enroll in a Medicare Advantage plan, it will likely already include prescription drug coverage.
What is Medicare Part D?
Original Medicare (Parts A and B) generally does not cover the prescription drugs you take at home. To get this coverage, you must join a Medicare-approved Part D plan offered by a private insurance company.
How do Part D plans work?
- The Formulary: Every Part D plan has a formulary, which is a list of covered drugs. Plans place drugs into different "tiers" on their formularies. Drugs in lower tiers generally cost less than drugs in higher tiers.
- Monthly Premium: You pay a monthly premium to the insurance company for your Part D plan.
- Deductible: Many plans have a yearly deductible you must meet before the plan begins to pay its share.
- Copayments & Coinsurance: After you meet the deductible, you will pay a copayment (a set dollar amount) or coinsurance (a percentage of the cost) for your covered drugs.
The Late Enrollment Penalty
If you go without creditable prescription drug coverage for 63 continuous days or more after your Initial Enrollment Period is over, you may owe a late enrollment penalty if you try to sign up for Part D later.
This penalty is permanently added to your monthly premium for as long as you have Medicare drug coverage.
When can you enroll?
You can enroll in a Part D plan during your Initial Enrollment Period. If you need to make changes to your plan, the best time to do so is during the Annual Enrollment Period (Oct 15 - Dec 7) each year, as plan formularies and costs can change.
Find a Plan That Covers Your Medications
The right Part D plan depends on the medications you take. Share your prescription list on the consultation form and Medicji will compare formularies and costs for plans in your area.