What is Medicare Prescription Drug Coverage?
Medicare Part D is the government's prescription drug benefit, created by the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The Medicare program offers prescription drug coverage to all individuals with Medicare.
A Medicare beneficiary can get prescription drug coverage through one of two options:
- Medicare Part D Prescription Drug Plans, also known as "PDPs", are stand-alone prescription drug plans that are approved by Medicare and offered by a private insurance company. Medicare beneficiaries can sign up for Medicare Part D plans to add drug coverage to their Original Medicare coverage, Medicare Supplement (or Medigap) plan, or certain Medicare Advantage plans, including Cost Plans, Private Fee-for-Service (PFFS) plans, and Medical Saving Account (MSA) plans. Anyone enrolled in either Medicare Part A or Medicare Part B is eligible to enroll in a Medicare Part D plan.
- Medicare Advantage Prescription Drug Plans, also known as "MAPDs", are Medicare Advantage health plans that offer prescription drug coverage. A Medicare beneficiary can access the same Part D drug coverage by signing up for MAPDs that offer both health and drug coverage. To enroll in this type of plan, you need to be enrolled in both Medicare Part A and Part B.
In either scenario, a Medicare beneficiary would be required to pay the monthly premium charged by the plan and these premiums vary by insurance provider.
What is the Right Medicare Part D Plan for Me?
The number and variety of Medicare Part D stand-alone drug plans leave consumers with no easy answer to the question "What is the best Medicare Part D drug plan?" Consumers must compare Part D drug plans and, with this drug plan comparison, determine which plan is most affordable and advantageous given their individual drug usage, pharmacy availability, and other factors important to them.
PlanPrescriber.com allows you to compare Medicare Part D plans using our plan comparison tool. The tool personalizes annual cost estimates for plans based on the drugs you indicate you use monthly so that you can replace the generic question "What Medicare Part D plan should I choose?" with the more specific "What is the right Medicare Part D plan for me?"
Compare Medicare Part D Plans
Each Medicare Part D drug plan has its own list of covered prescription drugs called a "formulary." Medicare requires all Part D prescription drug plan options to cover at least two or more medications within each therapeutic category (e.g. antidepressant, antibiotic). Medicare specifically excludes Part D plans from covering over-the-counter drugs and medications treating fertility, hair growth, and some other conditions.
Since each Medicare Part D plan can cover different drugs, it is essential to evaluate all available Medicare Part D plans in your area to determine:
- If your drugs are covered
- What are the estimated out-of-pocket expenses you should expect to pay during the year for your drugs and plan premiums
- If there are any limitations placed on your drugs (e.g. monthly quantity limits, prior authorization)
PlanPrescriber's free Medicare Part D plan comparison tool can answer the above questions for your personalized medication usage.