Expand your Medicare coverage with a Medicare Advantage Plan. Some plans may offer additional coverage for prescription drugs, dental and vision.
5 things to know about Medicare Part D drug plans:
Medicare Part D provides prescription drug coverage for Medicare enrollees. Part D plans are offered by private insurers, not the federal government.
Part D is optional coverage that works with many other forms of insurance, including Original Medicare, Medicaid, employer health plans, and, in some cases, Medicare Advantage plans.
Each Part D prescription drug plan may have varying benefits, costs, and rules.
In order to qualify for Medicare Part D coverage, you first must be enrolled in Medicare Part A and/or Part B.
Once you are eligible, you need to apply during a Part D enrollment period. If you do not sign up for a Part D plan when you are first eligible and you do not have creditable coverage, you may be required to pay a monthly late enrollment penalty once you do enroll.
If you already have a Medicare Advantage plan, you may not be eligible for a Part D plan, depending on the type of plan you are enrolled in.
If you have a Medicare Advantage plan with drug coverage, you can't add a standalone prescription drug plan.
|Enrollment period||Dates||What you can do during this period|
|Initial Enrollment Period (IEP)||Starts 3 months before the month you turn 65
Ends 3 months after the month you turn 65
|Sign up for a Medicare Part D plan|
|Medicare Open Enrollment Period (aka the Annual Enrollment Period, or AEP)||Starts October 15
Ends December 7
|- Sign up for a Medicare Part D plan
- Switch Medicare Part D plans
- Leave a Medicare Part D plan
|Special Enrollment Period (SEP)||Depends on your personal situation||Depends on your personal situation|
You must wait for an enrollment period to sign up for, make changes to, or leave a Medicare Part D plan.
Each beneficiary is granted an Initial Enrollment Period (IEP) when they first become eligible for Medicare.
This seven-month period begins three months before you turn 65 years old, includes the month of your birthday and continues for three additional months.
During your IEP, you may sign up for a Medicare Part D plan or a Medicare Advantage plan.
Also called the Annual Enrollment Period (AEP), this period takes place every year between October 15 and December 7.
During AEP, you may:
A Special Enrollment Period (SEP) may be granted at anytime throughout the year for people who have specific qualifying circumstances.
These qualifying situations include, but are not limited to:
A licensed insurance agent can help you find out if you qualify for a Special Enrollment Period. Depending on your qualifying circumstance, you may or may not be eligible to enroll in a Part D plan during a certain Special Enrollment Period.
Each year, the Centers for Medicare and Medicaid Services (CMS) rates all Medicare Part D and Medicare Advantage plans on a set of criteria and assigns a rating between one and five stars, with five being the highest rating.2
The Five-Star Enrollment Period runs each year from December 8 to November 30 of the following year.
Any beneficiary who is a member of a Part D or Medicare Advantage plan that does not hold a five-star rating may use this enrollment period to enroll in a plan that has a five-star rating.
You can only enroll in a five-star plan if one is available where you live.
If you need prescription drug coverage, it is important to enroll in a Part D plan during your Initial Enrollment Period or when you are first eligible. If not, you may face a late penalty.
If your IEP ends and there is a period of 63 days or more in a row when you do not have creditable prescription drug coverage, you may have a late enrollment penalty added to your monthly premium for as long as you have Medicare prescription drug coverage.
Drug coverage is creditable if it pays – on average – at least as much as the standard Medicare prescription drug coverage.
Part D plans have different formularies, tiers, coverage rules, and pharmacy networks.
Coverage rules such as quantity limits, prior authorization, and step therapy may limit how and when you receive your prescription drugs.
Part D plans also may have pharmacy networks, which may impact the cost of your prescription drugs.
More info: Part D benefits
Medicare Part D prescription drug plans don't pay for everything.
If you have a Part D plan, you may have to pay premiums, "donut hole" drug costs, and other out-of-pocket costs like deductibles and copayments.
There are many Part D plans to choose from. In 2019, there were 901 plans offered across 34 regions nationwide (excluding U.S. territories), according to the KFF.1
You should make sure to compare the following 3 factors when choosing your Part D plan:
Our online plan comparison tool can help you easily evaluate all of these factors for available plans in your area offered through this website.
Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.
Medicare Advantage plans and Medicare Part D plans are both offered by private insurance companies, and plan availability varies from state to state. Learn more about Medicare Part D plan enrollment nationwide and in your state.
You can also find more Medicare prescription drug coverage information and resources for your state.
More info: Medicare Part D plans by state
A Medicare formulary is the list of prescription drugs that are covered by a particular Medicare Part D or Medicare Advantage plan.
Each plan includes its own formulary that determines which drugs are covered by the plan and how much the drugs cost based on which tier the drug is classified into.
Drugs on a Medicare formulary are divided into tiers that determine the cost paid by beneficiaries.
For example, a tier 1 drug might consist of low-cost, generic drugs and require only a small copayment in order to fill a prescription. A tier 4 drug, however, might be a more expensive name brand drug that requires a higher copayment.
The number of drug tiers and the cost breakdown will vary according to each plan.
Drugs may be added or removed from the market at any time, and therefore drugs may be added or removed from a plan’s formulary. Drugs may also remain for sale on the market but be removed from a plan’s formulary for a variety of reasons.
Beneficiaries reserve the right to request that a Medicare plan cover a particular drug. You can also request to pay a lower amount for a covered drug.
All Medicare formularies generally must include coverage for at least two different drugs within most drug categories, and they must include all available drugs for the following categories:
A Medicare formulary won’t include over-the-counter drugs or weight-loss drugs.
Some drugs on a Medicare formulary come with certain types of restrictions, such as:
You may be able to find Medicare plan options in your area that feature a drug formulary that fits your prescription drug coverage needs.
To compare plans where you live, call to speak with a licensed insurance agent.
Or call TTY Users: 711 24/7 to speak with a licensed insurance agent.