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 own 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 and what are my options?
With Part D, you have two options, contingent that you already have Parts A and B:
- Receive coverage through a private insurance company (such as Priority Health) that offers a Medicare Advantage plan with prescription drug (MAPD) plans.
- Get a stand-alone prescription drug plan (PDP).
Is every Medicare Part D plan the same?
No. Medicare Part D monthly premiums, copayments and deductibles vary from one insurer to the next. You will be able to tell if what you’re taking is covered by checking the Priority Health formulary, which includes a list of approved drugs. If your prescription drugs are not included on this list, once you are a Priority Health Medicare member, you can ask us for an exception.
If I choose Part D, 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 am I eligible for Medicare Part D and when can I enroll?
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) – for instance 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 once you do enroll 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.
