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As a Medicare beneficiary, you do not automatically receive Medicare Part D prescription drug coverage. This coverage is optional, but it can be valuable if you take medications.
You can get Medicare Part D prescription drug coverage in two different ways, depending on whether you are enrolled in Original Medicare or Medicare Advantage. Medicare Advantage, also known as Medicare Part C, is an alternative way to receive your Original Medicare benefits through a Medicare health plan.
Medicare Part D coverage is available through a stand-alone Medicare Part D Prescription Drug Plan, which can be added to Original Medicare coverage, or through a Medicare Advantage Prescription Drug plan that includes prescription drug benefits under one plan.
You are eligible for Medicare Part D prescription drug coverage if you have Medicare Part A and/or Part B and live in the service area of a Medicare Part D Prescription Drug Plan.
If you decide to get prescription drug coverage through a Medicare Advantage plan, you must have both Part A and Part B and live in the service area of the Medicare Advantage plan.
You are first eligible to sign up for Medicare Part D during your Initial Enrollment Period, which is usually the same seven-month period as your Initial Enrollment Period for Original Medicare. This starts three months before you turn 65, includes your birthday month, and ends three months later.
You are eligible for Medicare Part D prescription drug coverage if you have Part A and/or Part B and live in the service area of a Medicare Part D Prescription Drug Plan.
If you get prescription drug coverage through a Medicare Advantage plan, you must have both Part A and Part B, live in the plan's service area, and confirm that the Medicare Advantage plan includes prescription drug coverage.
You do not have to enroll in Medicare Part D coverage. That decision will not affect your Original Medicare coverage. If you are currently taking medications, or feel that in the future this may be coverage you will need, it may be beneficial to enroll in a Part D plan.
You can enroll in either a stand-alone Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan, also called Medicare Part C, which includes Medicare Part D benefits to help with prescription drug costs.
If you do not sign up for Part D, you may have to pay for your medications out of pocket unless you have other insurance.
It is a good idea to sign up for Medicare Part D as soon as you are first eligible for Medicare. If you choose to enroll later, or go 63 consecutive days or more without Medicare Part D prescription drug coverage, you may have to pay a late-enrollment penalty unless you had creditable prescription drug coverage.
Creditable prescription drug coverage is coverage that pays at least as much as Medicare's standard Part D prescription drug coverage. Employer health coverage may be considered creditable prescription drug coverage. Your insurance should let you know every year whether your coverage is creditable.
You can also sign up for Medicare Part D coverage during the Annual Election Period, sometimes called Fall Open Enrollment or Open Enrollment for Medicare Advantage and Medicare prescription drug coverage. This takes place from October 15 to December 7 each year.
During this period, you can:
Once you enroll during open enrollment, your coverage generally starts on January 1 of the following year.
The Medicare Advantage Open Enrollment Period runs from January 1 through March 31 every year. If you are enrolled in a Medicare Advantage plan, you may have a one-time opportunity to switch to a different Medicare Advantage plan or drop your Medicare Advantage plan and return to Original Medicare.
If you return to Original Medicare, you may also be able to sign up for a stand-alone Medicare Part D Prescription Drug Plan. Most Medicare Advantage plans include prescription drug coverage already, and usually you cannot enroll in a stand-alone Medicare Prescription Drug Plan if you already have a Medicare Advantage plan, although some exceptions may apply.
In general, you can only enroll in a Medicare Prescription Drug Plan or make changes to Part D coverage during specific enrollment periods. However, some situations qualify you for a Special Enrollment Period, when you can enroll in a Medicare Part D Prescription Drug Plan or a Medicare Advantage Prescription Drug plan outside the normal enrollment periods.
Examples may include moving outside your plan's service area or qualifying for state Medicaid or prescription drug help. If you are not sure whether you have a situation that applies, feel free to call us. A licensed insurance agent would be happy to help you figure out what your options may be.
As part of the Inflation Reduction Act, the former Part D coverage gap, often called the "donut hole," changed beginning in 2025. For 2026, the annual out-of-pocket cap for covered Part D drugs is $2,100. Once a Medicare Part D enrollee reaches that limit, they pay nothing for covered medications for the rest of the year.
Your actual costs for Medicare Part D prescription drug coverage vary depending on the prescriptions you take, how often you take them, the plan you choose, whether you use a pharmacy in your plan's network, whether your drugs are on the plan's formulary, and whether you receive Extra Help paying Medicare Part D costs.
One cost to consider is your monthly premium. Most stand-alone Medicare Part D Prescription Drug Plans and Medicare Advantage Prescription Drug plans charge a monthly premium that varies by plan.
If you are enrolled in a Medicare Prescription Drug Plan and are also enrolled in Medicare Part B, you must continue paying your Medicare Part B premium. If you are enrolled in a Medicare Advantage plan, with or without prescription drug coverage, you must continue paying your Part B premium along with any premium for your Medicare Advantage coverage.
Medicare Prescription Drug Plans and Medicare Advantage plans with prescription drug coverage place covered medications into different cost tiers. Prescription drugs in higher tiers tend to cost more than those in lower tiers.
You can get help with Medicare Prescription Drug Plan costs if you qualify for income-based subsidies. Please see Medicare Subsidies for further details.
Contact us today to learn more about Medicare Part D Prescription Drug Coverage and which plans may be available in your area.
No. Medicare Part D prescription drug coverage is optional and is not automatically included with Original Medicare. You must enroll in a stand-alone Part D plan or a Medicare Advantage plan that includes drug coverage.
Original Medicare does not cover most self-administered medications. Part B may cover certain drugs administered in an outpatient setting, such as some infusion drugs, but most prescription drug coverage comes through Part D.
You can get Part D through a stand-alone Medicare Part D Prescription Drug Plan or through a Medicare Advantage Prescription Drug plan that includes drug coverage.
It is usually a good idea to enroll when you are first eligible for Medicare. Your Initial Enrollment Period generally begins three months before you turn 65, includes your birthday month, and ends three months after.
Yes. If you go 63 consecutive days or more without Medicare Part D prescription drug coverage or other creditable prescription drug coverage, you may have to pay a late-enrollment penalty if you enroll later.
The former coverage gap changed beginning in 2025. For 2026, covered Part D drug costs have an annual out-of-pocket cap of $2,100. After reaching that amount, you pay nothing for covered medications for the rest of the year.
Your costs depend on the medications you take, the plan you choose, the plan's formulary, drug tiers, deductible, copays or coinsurance, pharmacy network, and whether you qualify for Extra Help.
Yes. Extra Help, also called the Low-Income Subsidy, may help eligible people with limited income and resources pay Part D premiums, deductibles, and cost sharing.
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