Medicare Part D (Prescription Drug Coverage)

What is it? Under Part D, Medicare offers prescription drug coverage for everyone in Medicare. Part D plans are run by insurance companies and other companies approved by Medicare. You don’t have to participate in a Part D plan, and if you do not take many expensive drugs now, you may think, “Why bother?” However, it is worth considering. 

Many of us, as we age, will need various drugs to stay healthy. You have until three months after you turn 65 to enroll in Part D. You may have to pay a late enrollment penalty if you wait—and you carry that extra cost for as long as you’re covered under the plan. Note: If you have Medicare Parts A and B, you do not have prescription drug benefits. If you participate in a Medicare Advantage plan, prescription drugs may be

covered and you may not need Part D coverage. Be sure to check your plan.

What does Part D cost? Most Medicare Part D plans have a monthly premium. The Part D premium is in addition to the Part B premium. The premium amount you pay will vary by plan provider and by how many and what drugs the plan covers. Depending on the plan, you will also have to pay part of the cost of your prescriptions. If you have limited income and resources, you may qualify for assistance or a waiver of the

premiums and deductibles altogether.
What is the donut hole? Part D drug plans may have a coverage gap, often called the “donut hole.” Once you and your plan have paid up to $2,400 for prescriptions, you are responsible for all your drug costs (including the monthly premium) until you spend $3,051.25. At that point, you will be covered again and make a small co-payment until the end of the calendar year. Note: Some Part D plans offer coverage during this gap.
How do I decide on a Part D plan? Most prescription drugs, both brand-name and generic, are covered under Medicare Part D. However, the coverage varies by plan, so you must choose carefully. When you look at plans, it helps to compare three things:
• Cost: What will the coverage cost you—including premiums, deductible and the
payments for your drugs?
• Coverage: What benefits do you get? What drugs are covered? Do you need
prior authorization to get a drug you need? Is the donut hole covered?
• Convenience: Are the pharmacies near you a part of the plan? Is there a mailorder
option?
You can get current information on the Medicare drug plans by calling (800) Medicare,
TTY (877) 486-2048, or by going to www.medicare.gov and selecting “Compare
Medicare Prescription Drug Plans.”