Medicare Prescription Drug Plans

Medicare Part A and Part B does not provide prescription drug coverage at the pharmacy or for prescriptions received through the mail. It only includes coverage for prescription drugs while hospitalized. If you regularly take prescription medication, the out-of-pocket costs could be substantial if you only have Medicare Part A and Part B. Fortunately, private insurance carriers offer Medicare Part D plans to cover some costs of prescription drugs.

Enrollment in Medicare Part D is similar to Medicare Advantage. You can enroll during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday (starting with 3 months before you turn 65, continuing the month that you turn 65, and ending 3 months after you turn 65). Those who are under 65 may be eligible to enroll in a Medicare Part D plan if they have a qualifying disability. You may also enroll in a Medicare Part D plan during the Open Enrollment Period. Open Enrollment begins on October 15 and ends on December 7 in 2022. If you miss Open Enrollment, you could still get a plan if you qualify for Special Enrollment. You may qualify for Special Enrollment if you experience certain life changes, such as moving to a new state or losing health coverage.

Medicare Part D plans can be purchased as either (1) standalone coverage, which is in addition to Medicare Part A and Part B or a Medigap plan, or (2) as part of a Medicare Advantage plan.

Medicare Part D: Coverage and Costs

Though Medicare Part D plans are provided by private carriers, they are still regulated by the government. All Part D plan must cover the following:

• At least two different drugs from all categories of medications.
• At the least the majority of drugs from the following categories:
  • Cancer
  • Immunosuppressants
  • Anti-depressants/anti-psychotics
  • HIV/AIDS

When shopping for a plan, it is best to check if the prescription drugs that you currently take - or those that you think you might need at one point - are covered as part of the plan. Each plan has a different list of covered drugs. This is known as the plan’s “formulary.” If a drug is not on the list, then you generally have to pay the full price for that drug.

There are two types of Medicare Prescription Drug Plans:

The premiums for Part D Medicare plans can vary from carrier to carrier and from state to state.

For those currently on Medicaid or Supplemental Security Income (SSI), you may qualify for the Medicare Extra Help Program. The Medicare Extra Help Program is a government subsidy program that reduces your Part D premiums and deductibles. It can also remove the “donut hole”, giving you coverage with no limits.

Quick Facts:

• You can buy a Medicare Part D plan separately or as part of a Medicare Advantage plan.
• Rates can vary across carriers and the state you live in.
• Plans by law are standardized to cover the most common medications. However, when shopping for a plan, it is important to check the plan’s formulary, or the exact medications the plan covers.
• Medicare Part D plans can be purchased during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday – 3 months before you turn 65, the month you turn 65, and 3 months after you turn 65 - or during the Open Enrollment Period, which begins on October 15 and ends on December 7. You may still be able to enroll in a plan if you miss these enrollment windows if you experience certain life changes, such as moving or losing health coverage.
• Those who are under 65 may be eligible to enroll if they have a qualifying disability.

Please submit your zip code to start comparing Medicare Part D plans You can also call (833) 793-1161 TTY users 711  Mon - Fri: 6am - 5pm, Sat: 5am - 8pm PT to speak with a licensed insurance agent.