Medicare Part D

Medicare Prescription Drug Plans

Medicare Prescription Drug Plans are an optional benefit available to all Medicare beneficiaries. There are only two ways to get coverage for Medicare Prescription drugs. A beneficiary must either enroll into a Medicare Health Plan (usually a Medicare Advantage Plan) that includes prescription drug coverage, or they must enroll into a stand-alone prescription drug plan. Both of these options for Prescription drug coverage are offered by private companies.

Who can Enroll in a PDP?

Any Medicare eligible beneficiary can enroll into a Prescription Drug Plan. In order to be eligible, a beneficiary must either be entitled to Part A or enrolled in Part B of original Medicare. A plan member must also live in the service are for the plan they wish to enroll.  

You will not be eligible to enroll in a stand-alone PDP if the Medicare Health plan that you are enrolled in already included prescription drug coverage.

How much Does a PDP Cost?

The monthly premium for your PDP plan can vary depending on the type of plan that you choose to enroll into. The average monthly premium in the US in 2020 is $32.74. In addition to the monthly premium a Medicare beneficiary may also need to pay a Part D deductible and per prescription cost sharing.  

Medicare Prescription drug coverage is an optional benefit but if a beneficiary doesn’t enroll into a PDP plan when they are first eligible then they may pay a penalty if they decide to enroll into a plan at a later date. Generally, a beneficiary will pay this penalty for as long as they have prescription drug coverage.

Each plan can have flexibility in the design of their plan formulary. It is critically important to compare your costs associated with each of your prescriptions on each plan to determine what type of drug coverage and what type of plan may be the best fit for your needs.