Medicare Part D Plans
Neither Part A nor Part B of the traditional Medicare program includes prescription drug coverage. For people over 65 who rely on prescription medication to maintain their health, Medicare Part D provides prescription drug coverage for anybody who qualifies for Part A or Part B regardless of health status or income level.
In order to receive prescription drug coverage, you must enroll in a Medicare Prescription Drug Program. Part D plans are offered by Medicare-approved private companies. Many Medicare Advantage plans cover both prescription drugs and medical care so long as you have both Part A and Part B. If you have Original Medicare, you must enroll in a separate Part D plan if you want your medication covered. If you want prescription drug coverage, select the Part D plan you are interested in by enrolling online, over the phone, or by paper application.
Enrolling in prescription drug coverage is completely voluntary for most people unless you are currently getting your drugs through Medicaid. If you already have sufficient prescription drug coverage through another service, it is not necessary to enroll in a Part D plan. Remember, you will most likely have to pay a premium for your Part D coverage, although there are subsidies available for people with limited incomes. However, you may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan (Part D), or equivalent, or without a Medicare Advantage Plan (Part C) (like an HMO or PPO) or other Medicare health plan that offers Medicare prescription drug coverage, for any continuous period of 63 days or more after the Initial Enrollment Period is over.
Part D plans vary in cost and coverage by region and by carrier, so it is important to determine which plan is right for you. Many Part D plans also have a coverage gap, meaning that they will only cover up to a certain dollar amount for your prescription medication. Once you spend more than that amount, you must pay the full cost of your prescription drugs until you reach the out of pocket obligation. After you surpass the out of pocket obligation, you are only responsible for a co-payment. Not all Part D plans cover all the prescription drugs that you may be taking. Your copayment will vary depending on your income and on the types of medication that you need.
Part D plans only cover medically necessary drugs. Part D plans across the board do not offer coverage for cosmetic uses, over the counter drugs, weight loss, or other drugs that are not deemed medically necessary. Drug cost and coverage varies from plan to plan, so it is important to select a plan based on your own personal needs.