Medicare Part D

Medicare Part D is an insurance plan that helps pay for your prescription medication. 

Original Medicare does not come with this kind of coverage. You’ll have to purchase a standalone plan or receive it through a Medicare Advantage plan.

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What does Medicare Part D cover?

Part D is required to provide a standard level of coverage set by Medicare. 

Each plan will have a list of drugs covered on your plan called a formulary. 

Drugs covered will be placed into different “tiers” on the formulary. 

Both brand-name prescription drugs and generic drugs are included and that’s normally how the tiers are decided. The formulary includes at least two drugs in the most commonly prescribed categories and classes.

Your drug plan can make some changes to its drug list during the year if it follows guidelines set by Medicare. Your plan can change its drug list during the year because drug therapies change, new drugs are released, or new medical information becomes available.

However, they are required to give you at least 30 days notice unless the FDA says the drug is unsafe or its maker withdraws it from the market.

Drugs that are not covered

No matter which company provides your plan, these are the drugs not covered under any prescription drug plan: 

  • Weight loss or weight gain drugs
  • Any drugs for hair growth
  • Fertility drugs
  • Drugs for erectile dysfunction
  • Any over-the-counter drugs

Costs of Part D

These are the costs associated with a prescription drug plan you can compare when shopping plans: 

  • Premium
  • Deductible
  • Copays
  • Late enrollment fee

You can avoid the late enrollment fee if you sign up when you are first eligible — when you are first eligible for Medicare. Your initial enrollment period spans the three months before you turn 65 and the three months after your 65th birthday.

Drugs all plans must cover

Each Part D plan is required to 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 were already paid for under Part B.

Missed your initial enrollment period?

You can still purchase a plan during the annual election period that runs from October 15 through December 7.