Medicare Part D

Private insurance companies may provide and coordinate prescription drug coverage in plans known as Medicare Part D. These private insurance companies must be Medicare-approved. If you reside in a service area with a Medicare Part D plan and you are eligible for Original Medicare, you may sign up for Medicare Part D. Medicare Prescription Drug coverage is optional. Be sure to enroll when you become eligible to avoid a late-enrollment penalty.

If you are enrolled in Medicare Part A and B, you may enroll into a stand alone Medicare Part D plan. If you are enrolled in a Medicare Part C plan, you may get coverage from a plan that includes prescription drug benefits known as a Medicare Advantage Prescription Drug plan. Plan premiums and out of pocket costs may vary from plan to plan.

Medicare Part D plans contain a list of drugs covered by the plan known as a formulary and they vary from plan to plan. At any time, the formulary may change within your plan. You may want to review your Medicare Part D plan coverage to ensure your plan covers the medications you will need now and in the future. Every Fall you should review your plan’s Annual Notice of Change to ensure your plan will still cover your prescription drugs for the upcoming year.

Medicare Coverage Gap

Your Medicare Part D plan pays for your prescription drug coverage up to a certain amount. Up to a yearly amount, you may need to pay all costs on your own. This is known as the coverage gap, the limit on what your Medicare Prescription Drug plan will pay. This gap applies to both Medicare Part C and Medicare Prescription Drug Plans.