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Medicare Part D (Prescription Drug Coverage)

  • Provided through private insurance plans—either stand-alone or as part of Part C/Medicare Advantage plans.
  • Plans must accept anyone who is eligible and enrolls (no pre-existing condition clause).
  • Important to enroll when first eligible (unless you have creditable drug coverage), otherwise will incur a penalty for the rest of your life if enrolling later (unless eligible for Low Income Subsidy).
  • Plans have different formularies (drug lists) and cost structures.
  • Individual is eligible for Part D if they have Part A or Part B.
  • Two ways to get Part D drug coverage:
  • If beneficiary has Original Medicare, they can purchase a stand-alone prescription drug plan
  • If beneficiary has Medicare Advantage Plan, Part D is generally included, and beneficiary receives all Medicare benefits from one plan.

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