Prescriptions
Part D Prescription Drug Coverage Explained
Every plan covers a different list of drugs at different tiers. That is why there is no plan that is cheapest for everyone, and why your own list has to be checked by name.
Every plan has its own list
Part D plans each publish a formulary, which is the list of drugs they cover and the tier each drug sits on. Two plans available in the same county can both cover your medication and still treat it completely differently, because one places it on a preferred tier and the other does not.
This is the single most common place people lose money without realising it. The monthly premium is the visible number, so that is what gets compared, but for most people the tiers are what actually determine the yearly cost.
What changes the answer
- Which pharmacy you use. Many plans have preferred pharmacies where the same drug costs noticeably less.
- Mail order. Often priced differently from retail for maintenance medications.
- Quantity. A ninety day fill is not always three times a thirty day fill.
- Prior authorisation and step therapy. A drug can be covered but require approval, or require trying something else first.
Coverage changes every January
Formularies are allowed to change each plan year. A medication on a preferred tier this year can move next year, and your plan is not going to call you about it. This is the main reason a yearly review is worth the ten minutes even when nothing about your health has changed.
Help with the cost
There is a federal programme, usually called Extra Help or the Low Income Subsidy, that assists people with limited income and resources in paying for Part D. Many people who would be eligible never apply because they assume they earn too much. The limits are higher than most people expect. If cost is a factor, ask about it directly rather than assuming. More on that here.
The late enrollment penalty
If you go without creditable drug coverage after you are first eligible, a penalty is added to your Part D premium and it stays there for as long as you have Part D. Like the Part B penalty, it is permanent and entirely avoidable.
Questions
Commonly asked
Why is my drug cheaper on one plan than another?
Because each plan places drugs on its own tiers and negotiates its own pricing. The same medication can sit on a preferred tier for one plan and a higher tier for another.
Do I need Part D if I take no medications?
It is worth considering. Going without creditable coverage attaches a permanent late enrollment penalty if you need drug coverage later, and health changes are not something you can schedule.
What if my drug is not covered at all?
There is a formal exception process, and often a covered alternative in the same class. Either way it is worth knowing before you enrol rather than at the pharmacy counter.
Which one is right depends entirely on you
There is no plan type that suits everybody. It comes down to which doctors you want to keep, which prescriptions you take, whether you travel, and what you could absorb if something went wrong. That is a ten minute conversation, not a web page.
Medicare Advantage Plans: How Part C Works
A private plan that takes over how you receive Parts A and B, usually with drug coverage included and a cap on what you can spend in a year.
Medicare Supplement (Medigap) Plans Explained
You keep Original Medicare and add a policy that covers what Medicare leaves to you. Any doctor who accepts Medicare works, with no network to check.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.