Medicare Part D

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

Original Medicare does not offer any coverage for prescription medication. 

You can get Medicare Part D as a standalone plan or through a Medicare Advantage plan.

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What Medicare Part D covers

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

Plans place the drugs covered into different “tiers” on the list of drugs covered — called a formulary. 

The tiers are normally broken up by brand-name and generic drugs and each tier will be priced differently.

Your formulary will include at least 2 drugs in the most commonly prescribed categories and classes.

Drug plans can make changes to its drug list during the year as long as the insurance company follows guidelines set by Medicare. Your plan may change its drug list during the year because drug therapies change, new drugs are released, or new medical information becomes available.

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

Medicare Part D plans do not cover certain drugs

There are drugs that are not covered under any prescription drug plan: 

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

The costs for Medicare Part D

Your premium will depend on where you live, but these are the costs for prescription drug plans you can compare when shopping plans: 

  • Premium
  • Deductible
  • Copays
  • Late enrollment fee

If you do not have creditable prescription drug coverage and choose to sign up for a Part D plan later, you’ll have a late penalty added to your premium.

Part D’s penalty is 1% of the national base premium per consecutive month that you went without coverage and then rounded to the nearest 10 cents. The national base premium is $32.74 per month in 2020. That’s an additional $3.90 per month if you went without coverage for one year. 

Your initial enrollment period spans the three months before you turn 65 and the three months after your 65th birthday. This is when you will want to get coverage to avoid the late penalty.

Drugs all prescription drug plans are required to 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.