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Medicare Part D

Senior Benefit Solutions Medicare Part D

Medicare Part D is the final part of the Medicare program. Part D encompasses all prescription drug plans. Medicare beneficiaries can purchase a stand-alone Part D plan or choose one bundled into a Medicare Advantage plan.

What does Medicare Part D cover?

Part D plans are required to cover a wide range of prescription drugs. Each plan has a “formulary,” which is the list of prescription drugs that it covers. Each covered medication falls into one of the formulary’s “tiers.” The cost of the drug is dictated by which tier it calls into. The higher the tier, the higher the cost.

While Part D plans do not offer coverage on all medications, drugs in protected classes must be included. This includes drugs used to treat cancer and HIV/AIDS.

Other protected medications include antidepressants, antipsychotics, immunosuppressants, and anticonvulsive treatments for seizure disorders.

Part D policyholders may request an exception or file an appeal if they need medication not on the formulary.

How much does Part D cost?

As with all plans associated with Medicare, premiums will vary based on several factors.

Individuals must compare the medications they are currently taking with those offered by each plan’s formulary. The simplest way to do this is to speak to an agent who can access many Part D carriers to find the one that offers the most coverage.

Pills, medicine, and pharmaceutical drugs laying on a Prescription Drug Coverage RX pad.
No one is automatically enrolled in Part D.

How do I enroll in Prescription Drug Coverage?

No one is automatically enrolled in Part D. Medicare beneficiaries must enroll in a Part D plan in the area they reside. This can be accomplished on the website or with your insurance agent.

Individuals who choose to enroll in a Medicare Advantage plan with prescription drug coverage, also known as an MAPD, will not need to enroll in a separate Part D plan.

Enrollment Periods

You are eligible to enroll in a Part D plan as soon as you have enrolled in Medicare Parts A and B. This Initial Enrollment Period begins three months prior to your 65th birthday and extends to three months following your 65th birthday.

The Annual Election Period occurs each fall from October 15 to December 7. During this time, you may choose to change your Part D plan. This is a crucial enrollment period. In September, you will receive an Annual Notice of Change from your Part D carrier. This describes any changes occurring in your policy. Review this carefully, as there are often modifications that may negatively impact your situation.

If you decide you want to keep your current policy, no action is required. Your plan will renew automatically in January.

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