Medicare Part D Prescription

Medicare Part D Basics
Original Medicare does not cover or subsidize the cost of prescription drugs. Medicare Part D, also called Prescription Drug Plans or PDP, is a Medicare program designed to help seniors finance the high costs of prescription drugs and premiums.

What it covers
Medicare Part D encompasses a variety of drug plans—each of which covers its own set list of drugs (called a formulary). The cost of a drug plan varies based on which types of drugs you need and whether you use a pharmacy in your plan’s network.

How does Medicare prescription drug coverage (Part D) work?
Medicare prescription drug coverage is an optional benefit. Medicare offers drug coverage to everyone with Medicare. Even if you don’t take prescriptions now, you should consider joining a Medicare drug plan. If you decide not to join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or get Extra Help, you’ll likely pay a late enrollment penalty if you join a plan later.

Generally, you’ll pay this penalty for as long as you have Medicare prescription drug coverage. To get Medicare prescription drug coverage, you must join a plan approved by Medicare that offers Medicare drug coverage. Each plan can vary in cost and specific drugs covered. Visit the Medicare Plan Finder at Medicare.gov/find-a-plan for more information about plans in your area.


THERE ARE 2 WAYS TO GET MEDICARE PRESCRIPTION DRUG COVERAGE:

Medicare Prescription Drug Plans
These plans (sometimes called “PDPs”) add drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) plans, and Medicare Medical Savings Account (MSA) plans. You must have Part A and/or Part B to join a Medicare Prescription Drug Plan.

Medicare Advantage Plans (like HMOs or PPOs)
You get all of your Part A, Part B, and prescription drug coverage (Part D), through these plans. Medicare Advantage Plans with prescription drug coverage are sometimes called “MA-PDs.” Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.

In either case, you must live in the service area of the Medicare drug plan you want to join. Both types of plans are called “Medicare drug plans” in this handbook. If you have employer or union coverage Call your benefits administrator before you make any changes, or sign up for any other coverage. Signing up for other coverage could cause you to lose your employer or union health and drug coverage for you and your dependents.

When can I join, switch, or drop a Medicare drug plan?
• When you first become eligible for Medicare, you can join during your Initial Enrollment Period.
• If you get Part B for the first time during the General Enrollment Period, you can also join a Medicare drug plan from April 1 – June 30. Your coverage will start on July 1.
• You can join, switch, or drop during Open Enrollment, between October 15–December 7 each year. Your changes will take effect on January 1 of the following year, as long as the plan gets your request during Open Enrollment.
• If you qualify for a Special Enrollment Period.

Special Enrollment Periods
You generally must stay enrolled for the calendar year. However, in certain situations, you may be able to join, switch, or drop Medicare drug plans at other times. Some examples are if you:

• Move out of your plan’s service area.
• Lose other creditable prescription drug coverage.
• Live in an institution (like a nursing home).
• Have Medicaid.
• Qualify for Extra Help.