What are Medicare Part D Prescription Drug Plans?

What are Medicare Part D prescription drug plans?

Most of us are used to health insurance plans that have prescription drug coverage built right in. Medicare is a little different.
If you’re enrolled in Original Medicare and you want help paying for your prescriptions, you have two options:
  • Enroll in a Medicare Part C, or Medicare Advantage, plan that covers prescription drugs. These plans work a lot like other health insurance plans you might be used to.
  • Enroll in a stand-alone Medicare Part D plan. These are also called prescription drug plans.
  • How do I get a Medicare Part D plan?

    You can buy Part D prescription drug plans from health insurance companies or other private companies. The federal government regulates them.
    You can sign up for Part D around the time you turn 65. You have a 7-month window around your birthday. It's called the initial enrollment period. This is the same as the initial enrollment period for Medicare Parts A and B. You’ll need to enroll in Medicare Part A or B before you can enroll in a Part D plan.
    When you enroll in a Part D plan is important. If you don’t enroll in a Medicare Part D prescription drug plan when you’re first eligible, you might have higher monthly premiums when you do join a plan.
    You can find out more about the enrollment timeline in our “When to Enroll” section on the home page.

    How much do Part D plans cost?

    How much you pay depends on how you get your Part D coverage.
    If you have a separate Part D prescription drug plan, you pay a monthly premium to your health insurance company. After that, each plan works a little differently. Some plans have an annual deductible you have to meet before you get help paying for your prescriptions. Once your coverage kicks in, you’ll either pay a copay or coinsurance for most drugs you buy.
    What you pay for your prescription drugs will depend on:
  • Whether you buy brand name or generic drugs. Read about the benefits of generic drugs.
  • Whether they’re in your plan’s drug list and what drug tier they're in. Learn about how to read a drug list.
  • Whether you go to a pharmacy that’s in your plan’s network. Find a pharmacy.
  • What coverage stage you’re in. You'll pay more when you're in the coverage gap, or "donut hole." You'll pay less before and after the coverage gap. You can read more about how the coverage gap works with Part D plans here
People with lower incomes might qualify for help paying their Part D premiums.

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