Medicare Prescription Drugs Plans (Part D)

Prescription drug benefit (Part D) is the part of Medicare that provides outpatient drug coverage.

You can get prescription drug coverage (Part D) in one of two ways: through a “stand-alone” Part D drug plan or through a Medicare Advantage plan, such as an HMO or PPO. Both types of plans are offered by private insurance companies that are regulated by Medicare. 

If you need help choosing a Drug plan, please fill out the form at the bottom of this page to schedule a time to talk with us.

Part D

What are the enrollment requirements

YOU MUST BE ENROLLED IN MEDICARE A & B

You Must live in the plan’s service area

Whether you choose a stand-alone plan or an Advantage plan, you must enroll during a designated enrollment period:

  • Your initial enrollment period (IEP), which runs for seven months, of which the fourth is the month of your 65th birthday.
  • A special enrollment period (SEP), which you’re entitled to in certain circumstances
  • The annual open enrollment period (Oct. 15 to Dec. 7 each year) when you can join a drug plan for the first time if you missed your deadlines for your IEP or a SEP, or switch from original Medicare to a Medicare Advantage plan, or switch from one Medicare Advantage plan to another, or switch from one Part D drug plan to another.
  • The annual “disenrollment” period (Jan. 1 to Feb. 14) when you can opt out of a Medicare Advantage plan (regardless of how long or short a time you’ve been enrolled) and return to the original Medicare program. During this period you can also join a stand-alone Part D drug plan, provided that you had been receiving drug coverage from the Medicare Advantage plan. 
  • A general enrollment period (Jan. 1 to March 31 each year), if you missed your deadline for signing up for Medicare (Part A and/or Part B) during your IEP or an SEP. In this situation Medicare coverage will not begin until July 1 of the same year in which you enroll. You can sign up for a Part D drug plan or a Medicare Advantage plan between April 1 and June 30 to begin receiving drug coverage under it on July 1. 

If you fail to sign up during one of these time frames, you will be liable for late penalties, based on how many months you were without Part D or alternative creditable coverage since turning 65, which will be added to your Part D drug premiums for all future years.

What Medicare Part D drug plans cover

Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different “tiers” on their formularies.

Plans include both brand-name prescription drugs and generic drug coverage. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes.

Here’s an example of a Medicare drug plan’s tiers (your plan’s tiers may be different):

  • Tier 1 – most generic prescription drugs
  • Tier 2 –  preferred, brand-name prescription drugs
  • Tier 3 –  non-preferred, brand-name prescription drugs
  • Specialty tier – high cost prescription drugs

How does Part D coverage work?

Annual Deductible

For plans with a deductible, this is the amount you may have to pay before your drug plan begins to pay its share of your covered drugs.
Initial Coverage


You pay only the plan's copay or coinsurance for your covered drugs. You stay in this stage until your year-to-date drug costs total $4,430.
Coverage Gap


You pay 25% of the price for all drugs (plus a portion of the dispensing fee). You stay in this stage until your year-to-date out-of-pocket costs total $7,050.
CATASTROPHIC COVERAGE

Your share of the cost for a covered drug will be either 5% coinsurance or $3.95 for a generic drug and $9.85 for all other drugs, whichever is greater. Your plan will pay the rest of the cost.

You have many options

Don’t get confused about all the different terms and numbers you see here. It’s our job to help you find the plan that will work for you. 

You have no obligation to do anything if you decide to give us a chance. All our services are free to you, we get paid by the insurance companies if you decided to apply for a plan throughout us. 

We don’t get paid unless you are happy so we are going to make sure you are set up correctly and we are going to keep working with you so that you never find yourself in a position of confusion or regret. You will not be talking to someone in a call center, we are local agents in your community.