All About Medicare Part D – What you Should Know to Get Coverage

In general, prescription drug coverage isn’t included in Original Medicare. To get this coverage, many people enroll in a Medicare Part D plan. There are two main ways to get Medicare prescription drug coverage: a standalone Medicare Part D plan or a Medicare Advantage (Part C) plan with a prescription drug benefit. Which option might be right for you?

Am I eligible?

To be eligible for Part D prescription drug coverage through Medicare, you must first be enrolled in  Original Medicare (Medicare Parts A and B) and paying your Medicare Part B premium. You can enroll in a Part D prescription drug plan during your Initial Enrollment Period (IEP) when you first become eligible for Medicare or during the Medicare Annual Enrollment Period (AEP), which is October 15 – December 7th. If you dropped your Medicare Advantage plan to go back to Original Medicare, you can enroll in a Part D prescription drug plan from January 1 to February 14 each year. Some people may qualify for a Special Enrollment Period that doesn’t fall during one of these other enrollment periods.

What’s the difference between coverage types?

Medicare Part D prescription drug coverage is not automatic. You must enroll in a plan if you want coverage. If Original Medicare meets your other coverage needs and you just need extra help paying for your prescriptions, you can purchase a standalone Medicare Part D prescription drug plan (PDP). Another way to get Part D prescription drug coverage is to purchase a Medicare Advantage (Medicare Part C) plan that offers a prescription drug benefit. Not all Medicare Advantage plans offer this benefit, and coverage can vary widely from plan to plan.

How do I get the most value for my health care coverage needs?

It’s important to consider your health needs when thinking about the prescription drug benefit that might be right for you. Keeping your Original Medicare coverage and purchasing a separate prescription drug plan may be a good option. If your health care coverage needs include a wider range of benefits plus help paying for prescriptions, however, a Medicare Advantage plan with prescription drug benefits may offer greater value. Medicare Advantage plans include hospital and medical benefits, but many also include additional benefits like vision, hearing, dental and wellness care. Which plan you choose depends on your individual coverage needs.


What will my plan costs be?
Prices for Part D prescription drug coverage in both Medicare Advantage plans and standalone plans differ. You should research the plans you’re interested in to find out specific costs to you. All plans have similar types of cost sharing, though:

  • Premiums – A premium is the amount you pay each month to be covered by a certain plan. These costs can vary widely from company to company.
  • Deductible – The deductible is the set amount you have to pay out of your own pocket before the plan begins to cover a portion of the costs.
  • Copayment – Your copayment is the amount you pay at the time of service for your prescription drug order. For example you might pay $10 or $15 each time you pick up your prescriptions at the pharmacy.
  • Coinsurance – Defined in percentages, coinsurance indicates the split in health costs between you and your insurance company. For example, you pay 20% of the bill and your plan pays 80%.

What happens if I delay signing up for Part D coverage or my coverage lapses?

If you don’t sign up for Medicare Part D coverage as soon as you are eligible, you may pay a penalty on your premium, unless you qualify for an exception. This penalty is set by Medicare. For each month you delay, you may pay an additional 1% (of the average premium) per month. You will pay that penalty for as long as you’re enrolled in Medicare Part D. If you had prescription drug coverage from another source, such as an employer or union, remember that your coverage may lapse or end when you become eligible for Medicare. If you are without coverage for more than 63 days, you may also have to pay a penalty.

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