Prescription Drug 
Coverage, Made Simple

Medicare Part D helps pay for covered brand-name and generic prescription drugs. Coverage is provided through Medicare-approved private insurance companies, and each plan has its own premiums, covered medications, pharmacy network and cost-sharing.

You can receive prescription drug coverage through a standalone Medicare Part D plan that works alongside Original Medicare, or through a Medicare Advantage plan that includes prescription drug coverage. The appropriate option depends on how you receive your Medicare benefits.

Check whether the plan covers your prescriptions, the tier assigned to each medication, your estimated annual costs, deductible, preferred pharmacies and any coverage restrictions. The plan with the lowest monthly premium is not always the plan with the lowest total cost.

A formulary is a plan’s list of covered medications. Each prescription drug plan has its own formulary and may place medications on different cost-sharing tiers. Before enrolling, confirm that your prescriptions, dosage and form are covered.

Yes. Plans may have standard and preferred in-network pharmacies, and your cost can differ depending on where you fill a prescription. Using an out-of-network pharmacy may result in limited coverage or higher costs except under certain circumstances.

These are coverage rules a plan may apply to certain medications:Prior authorization: The plan must approve the medication before it will be covered.Step therapy: You may need to try another covered medication before the plan covers the prescribed drug.Quantity limits: The plan may limit how much medication it covers during a particular period.Your prescriber may request an exception when medically appropriate.

You can generally enroll when you first become eligible for Medicare. You may also make changes during Medicare’s Annual Election Period, October 15 through December 7, for coverage beginning January 1. Certain life events or eligibility changes may provide a Special Enrollment Period.

You may owe a late-enrollment penalty if you go 63 consecutive days or longer without Medicare drug coverage or other creditable prescription coverage after becoming eligible. The penalty is generally added to your monthly Part D premium for as long as you have Part D coverage.

Yes. A plan may change its premium, deductible, formulary, medication tiers, pharmacy network and coverage rules for the following year. Review the Annual Notice of Change you receive each fall and compare your coverage before making a decision.

Medicare’s Extra Help program may help eligible individuals with limited income and resources pay Part D premiums, deductibles and prescription costs. Some people qualify automatically, while others may need to apply.