What is Medicare Part D?
Part D is a bit more unique than its Medicare counterparts, as it helps cover prescription drug costs, unlike Original Medicare.
Why do I need Medicare Part D?
If you take prescription drugs, you should consider Medicare Part D prescription drug coverage. Original Medicare (Parts A and B) doesn't cover most drugs. If you don't have a Medicare Part D plan or other drug coverage, you'll pay for your drugs out of your pocket, which can really add up. Part D may help lower your prescription drug costs and help protect you against higher costs in the future.
How does Medicare Part D work?
If you already have Medicare Parts A and B, you have two options for Part D coverage:
- You can choose a Medicare Advantage plan (Part C) that includes prescription drug coverage (MAPD). MAPD plans are offered through a private insurance company, like Priority Health.
- You can enroll in a stand-alone Medicare Part D prescription drug plan (PDP).
Are all Medicare Part D plans the same?
No. Medicare Part D monthly premiums, copayments and deductibles vary from one insurer to the next. You can check so see if your drugs are covered by using the Priority Health formulary, which includes a list of approved drugs. You can also see your estimated drug costs by plan. If your prescription drugs are not included in the formulary, Priority Health Medicare members can ask us for an exception.
What will I pay for my Part D prescription drugs?
Starting in 2025, you’ll never pay more than $2,000 for Part D prescription drugs. Your true out-of-pocket (TrOOP) costs will be capped at $2,000 a year. After you’ve reached the cap, all drug copays are $0.
When can I enroll in Medicare Part D?
The sooner you apply for Part D, the better. Ideally, this is done during your initial enrollment period.
If you decide to wait to enroll in Medicare Part D and you don't have "creditable coverage" - coverage as good as Original Medicare, usually from an employer or union – you could end up paying a late enrollment penalty. This late enrollment fee will be added to your monthly premium and will continue for as long as you have Medicare. You'll pay a fee based on the following calculation: 1% of the national base premium for that year for every month you were eligible but not enrolled.
How do I qualify for Medicare Part D?
You must have an Original Medicare (Parts A and B) plan to qualify for Medicare Part D coverage. If you have Medicare Advantage (Part C), drug coverage is already included.