Find Medicare Part D Prescription Drug Plan Coverage
Fact checked Reviewed by: Leron Moore, Medicare consultant - Published: Jul 02, 2021
Medicare Part D is the private drug plan insurance offered through Medicare. A prescription drug plan helps cover the costs of medications, but there are many options to choose from each year. Those who are eligible to enroll can use Medicare’s tool to compare prescription drug plans in their state to see which one is the most cost effective for their individual needs.
What you should know
- 1 Medicare Part D is a private drug insurance plan offered to Medicare recipients. Failure to enroll in a Part D plan may result in a Late Enrollment Penalty.
- 2 If you have Part D prescription drug coverage, it covers a wide range of prescription drugs from the most commonly prescribed categories.
- 3 You can enroll in Medicare Part D as an addition to your Original Medicare coverage, or it could be combined with a Medicare Advantage Plan (Part C).
- 4 There are tools available to help you compare available prescription drug plans, and you have the option to change your plan each year as your needs change.
Medicare Part D is prescription drug coverage that’s available to people on Medicare. Unlike Part A and Part B, Medicare Part D is offered by private companies, and most people will have around 25-35 plans to choose from depending on their state. Overall, in 2021, there were nearly 1,000 PDPs offered nationwide.
You should plan to enroll in a Medicare prescription drug plan (PDP) when you are eligible (which is either when you turn 65, or when your creditable coverage through an employer ends). If you miss the cutoff, you’ll pay a Late Enrollment Penalty that will continue for the entire time you receive Medicare coverage – which may be the rest of your life.
With drug costs rising and the likelihood that you may need more medications later in life, it’s important to choose a Medicare Part D plan carefully – and reevaluate each year – to make sure you have adequate coverage.
How do you find the best Medicare Part D plan?
Choosing a Medicare Part D plan can seem overwhelming at first, but if you take the right approach and use the right tools, you will find the best plan for your needs. The first rule of thumb: Never choose a plan based only on the premium, says Kathe Kline, founder of MedicareQuick.com. “A lot of people think they can just choose the plan that’s the least expensive, but they’re not looking at the drugs themselves,” she says.
In 2021, the average monthly premium for Medicare Part D was $33.06, but the price can vary from $0 all the way up to a couple of hundred depending on the state and the plan.
But what may be a good deal for one applicant might not work well for another depending on how much their key medications will cost.
What should you look for in a Medicare Part D plan?
Beyond your premium and checking to see the coverage on your drugs (current prescriptions, or ones that your doctor says you may need), you should look at some other features when comparing plans. Some of the criteria to think about includes:
- If the drug plan lists preferred pharmacies (and if yours is one of them)
- What the coverage and cost is for your individual medications
- If you get discounts on mail-order prescriptions
- What the yearly deductible is, as it will vary by plan
Also, if you qualify for Extra Help to pay for your Part D plan, that may help lower your out-of-pocket costs, so be sure to look into that if you have a lower income.
Remember: Just because you do this research when you first sign up for your PDP, it doesn’t mean that your job is done. “You need to evaluate your Part D plan every single year,” says Kline. Not only might your own drugs change, but the plans themselves may be updated and that could impact how much you will pay for the medications you’re already taking going forward.
How can you find out if your prescriptions will be covered by a Medicare Part D plan?
Medicare.gov has a plan finder tool that lets you enter in your medications and zip code, and it will tell you which plans will save you the most money. While this is a great starting point, Kline cautions that the tool may not always have the most up-to-date information. “If I were to go on and find that Company X would save me a certain amount, I would then go on Company X’s website and verify that,” she advises.
If you choose to work with an insurance broker, they will typically have access to programs that have the most accurate information, adds Kline.
Remember that you’ll want to repeat this process every year around October 1st, especially if you have new medicines or your dosage amounts have changed. Then you have from 10/15 through 12/7 if you decide to change to a new Part D prescription plan, which goes into effect on January 1.
If at some point during the year your doctor prescribes a new medication that your plan has in a high tier or doesn’t cover at all, you should talk to them about prescribing something that is covered.
Or, you can ask the doctor to put in an appeal to the drug plan. A tier exception or a coverage determination will, in some cases, allow for a medication to be covered at a more affordable lower tier. Or, a previously not covered medication may be brought on to the formulary as a covered medication.
This expert was consulted for insight into the enrolling in Medicare Part D:
Kathe Kline, founder of MedicareQuick.com
- Featured Sources [-]
Medicare.gov: How to Get Prescription Drug Coverage | Last accessed June 2021
Medicare.gov: 6 Tips for Choosing Medicare Drug Coverage | Last accessed June 2021
Medicare.gov: Shop & Compare 2021 Plans with the Medicare Plan Finder | Last accessed June 2021
Medicare.gov: Find Your Level of Extra Help (Part D) | Last accessed June 2021
Medicare.gov: Yearly deductible for drug plans | Last accessed June 2021
Kaiser Family Foundation: An Overview of the Medicare Part D Prescription Drug Benefit | Last accessed June 2021
Leron Moore, Medicare consultant
Leron Moore has guided Medicare beneficiaries and their families as a Medicare professional for nearly 15 years. First as a Medicare provider enrollment specialist, and now a Medicare account executive, Moore works directly with Medicare beneficiaries to ensure they understand Medicare and Medicare Advantage Plans.