Medicare beneficiaries across the nation have the option of enrolling in a Medicare Part D plan to receive their prescription drug coverage. Part D plans are offered through private insurance companies that are contracted by Medicare, so costs and availability may differ between carriers and by location. Part D plans include stand-alone Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug (MAPD) plans. Each plan can vary in cost and drugs covered and helps cover the cost of outpatient prescription drugs and may help lower your prescription drug costs and help protect against higher costs in the future.
Enrolling in a Part D Plan
There are two ways to get Part D drug coverage.
- Stand alone Medicare Prescription Drug Plan (Part D). These plans (sometimes called “PDPs”) add drug coverage to Original Medicare.
- Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage.
Because plans have the opportunity to set their own monthly premiums, the costs associated with Part D plans may differ by insurance company. In general, each plan requires payment of a monthly premium in addition to your Part B monthly premium.
Other costs may include the following:
- Yearly deductible: The amount that you must pay before your plan coverage begins. The government sets a maximum deductible that may change each year, and some plans charge no deductible.
- Co-payments and coinsurance: You are responsible for paying these amounts for your medications after you have paid your plan deductible (if required).
- Coverage gap, or “donut hole”
If you decide not to join a Medicare Prescription Drug Plan (Part D) when you’re first eligible, or if you decide not to join a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, you’ll likely pay a Late Enrollment Penalty (LEP) unless you have other creditable prescription drug coverage