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Medicare Part D

Medicare Part D is the prescription drug benefit offered through insurance companies as either a stand-alone plan or beneficiaries can choose a Medicare Advantage plan that also features prescription drug coverage. This is Medicare Part D Explained.

Medicare Part D Synopsis 01

What does Medicare Part D cover?

Each Part D plan has a list of covered drugs called a formulary. If the drug you need is not on the formulary, you are allowed to request an exception, pay out of pocket, or file an appeal. 

These formularies differ from plan to plan so be sure to request a copy. However, each plan must cover all drugs in the following categories: 

  • HIV/AIDS treatment 
  • Antidepressants
  • Antipsychotic medications
  • Anticonvulsive treatments for seizure disorders
  • Immunosuppressants
  • Anticancer drugs (unless they are being covered under Part B)

Most vaccines are also covered under Part D unless they are already covered under Part B.

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How much does Part D cost?

Monthly premiums and copay differ from plan to plan. 

However, as discussed earlier, each plan has a formulary that lists different drugs that are covered. So, the cheapest plan may not always be the best choice. Be sure to speak with a licensed Medicare agent that double checks the plan you are interested in will cover all of your drugs.

How do I enroll in prescription drug coverage?

You can only enroll in a Medicare Part D plan in the service area in which you live. So, you can do so through an insurance provider that is licensed in Medicare services. You can also enroll in Medicare Part D through Medicare’s website. 

Some Medicare Advantage plans also include Part D coverage. Again, If this is how you would like to receive your prescription drug coverage, make sure it covers all the drugs you require.

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Enrollment periods

You can enroll in Medicare Part D when you enroll in Original Medicare. 

This is the three months before you turn 65 and the three months after your 65th birthday. 

There is also an annual election period from October 15 through December 7 in which you can enroll or disenroll from any drug plan. 

The insurance company with which you have your plan will mail you an Annual Notice of Change each September. This letter will detail all changes coming with your plan so you can decide if you would like to make a change. 

If you wish to keep your current coverage, you don’t have to do a thing. It will automatically renew in January.