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Prescription Drugs

Medicare Prescription Drug Coverage


Medicare Prescription Drug




Medicare Part D covers prescription drugs. A stand-alone Medicare prescription drug plan is required to get Medicare Part D coverage. It is also known as the Medicare Advantage prescription drug plan. Medicare-approved private insurance companies offer these plans.

Medicare Part D covers:

Each plan prescription drug coverage presented under Medicare part D offers a standard level of coverage set by Medicare. Each plan coverage varies according to the list of prescription drugs they cover and how they place drugs into different tiers on their formularies. Following there plans are covered in Medicare part D.

Covered prescription drugs list

Most Medicare Prescription Drug Plans or Medicare Advantage Plans with prescription drug coverage have their list specifying what drugs are covered. These plan lists also include the brand name and what a drug contains and helps people understand their requirements according to their different medical conditions.

Expand Generic drugs

According to the Food and Drug Administration (FDA), the list of the generic drugs contains the drugs that are copies of brand-name drugs such as:

  • Route of administration

  • Quality

  • Dosage form

  • Safety

  • Strength

  • Performance characteristics

  • Intended use

Made of the same ingredients as brand-name prescription drugs, pharmaceutical manufacturers need to get FDA certification before providing them commercially.

Expanded  Tiers

In Medicare Part D, few low-cost plans are also available and offer prescription drug coverage into different tiers. Each program has divided into levels. A drug present in the lower tier is less costly than the drug in the upper tier.
Examples provided below:

  • Tier 1 – Lowest co-payment and with the most generic prescription drugs

  • Tier 2 – Medium co-payment includes preferred brand-name prescription drugs

  • Tier 3 – Higher co-payment includes non-preferred brand-name prescription drugs

  • Specialty tier – Highest co-payment includes the high-cost prescription drugs

If your prescriber gives you a drug in the higher tier with the high cost and at the same time, a similar drug is also present in the lower tier at a low price. You have the option to file an exception and ask your plan for a lower co-payment.

Medicare Part D Costs

Your Medicare Part D cost will vary from plan to plan based on the specific program you choose and the prescriptions you take. And you can make payment for your Medicare plan D in the following ways:

  • Co-payments

  • Coinsurance

  • Premium

  • Yearly deductible

  • Costs for late enrollment penalty

  • Fees for the coverage gap

  • Costs for extra services

Your drug plan cost will also vary depending on:

  • The drugs you use

  • The plan you choose

  • Whether you go to a pharmacy

  • Whether the drugs are in your plan

  • Whether you get extra services

As you might already know, you can get Medicare prescription drug coverage in different ways.

  • A stand-alone Medicare Part D prescription drug plan – works alongside your Medicare Part A and or Part B benefits

  • A Medicare Advantage prescription drug plan – delivers your Medicare Part A, Part B, and Part D benefits all in one program.

Medicare Part D Enrollment

You can get yourself enroll in Medicare plan D offered by private companies in two ways:

  • Medicare Part D

The prescription drug plans augment your traditional Medicare coverage plans and specific Medicare cost plans, Medicare savings account plans, and Medicare private fee-for-service plans.

  • Medicare Advantage Prescription Drug plan

Medicare D plan includes prescription drug coverage along with Medicare Part A and Part B coverage.

You can only enroll in either of the plans mentioned above to have a Medicare Advantage plan that includes drug coverage and gets enrolled in a Medicare drug plan. In that case, you will automatically get disenrolled from the Medicare advantage plan and reverted to traditional Medicare. You can also choose not to enroll in Medicare Part D prescription when you already have creditable prescription drug coverage as it can be from your employer group plan.

Any person enrolled in the traditional Medicare plan Part A, Part B, and Part C is eligible to enroll in Medicare Part D Prescription Drug Plan. You need to have:

  • Enrolment in Medicare Part A and or Part B.

  • Residing in the service area of the company that is providing prescribed drug coverage.

Medicare Part D Eligibility

An individual who is eligible for a traditional Medicare plan, Part A and Part B will also sign for Medicare Part D prescription drug plan. You must need to enroll in both Part A and part be to be part of a Medicare Advantage prescription drug plan. In either case, you need to reside within the plan’s service area.

Medicare Part D Premiums

According to the Centers for Medicare & Medicaid Services, the average Medicare Part D premium will be $30.50 in 2021. Medicare part D drug plan has monthly premiums. Their monthly premium range starts from $0 to hundreds of dollars. Along with Part D premium, you will also pay your Medicare Part B premium every month.

To be in compliance with CMS guidelines, licensed Medicare agents are required to read this script before every call. "This call may be recorded for quality assurance or training purposes. We do not offer every plan available in your area. Currently, we represent 0-78 organizations which offer          0-2,613 products in your area. Please contact, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

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