Part D helps cover the cost of prescription drugs that Original Medicare doesn’t cover. Private insurance companies provide standalone Medicare Part D Prescription Drug Plans in exchange for monthly premiums you pay on top of Original Medicare premiums.
Alternatively, other private insurance companies offer Medicare Advantage plans with Part D included, or MAPD plans. This is another option for keeping Medicare costs more affordable.
Part D costs vary by insurance company and plan coverage. Depending on the plan, you may pay different monthly premiums, face different drug costs, and find that pharmacy networks vary as well. Formularies (also known as lists of covered drugs) vary by plan.
Part D Advantages
A standalone Part D plan is optional, but likely right for you if you
- Are enrolled in Original Medicare or a Medicare Advantage plan without Part D
- Take multiple medications
- Take expensive specialty drugs
- Want predictable budgeting for healthcare and pharmacy costs
Even if you’re not taking any medications right now, think about signing up for Part D coverage to avoid penalties later when you need a plan.
What Part D Covers
Plan D coverage is fairly simple. Your Part D plan will cover:
- Generic drugs
- Name-brand drugs
However, drugs on each standalone Part D plan’s formulary differ. The plan will likely cover only those medications (unless you jump through prior authorization hoops). When signing up for these plans, you must ensure that the medicines you need are already on your plan’s formulary.
California Part D Plans
The number of plans offered can range from one or a handful in some California counties to several in others. Weighing your options is critical when it comes to medications. Fewer Part D plans are available now than several years ago.
You also have the option of a Medicare Advantage plan with Part D included, or MAPD. Whether this is right for you requires a discussion in advance.
How I Help
I’m Jason Rubin, an independent medicare insurance broker serving San Fernando Valley residents. I can model your actual drug costs every month and throughout the year. We can also review:
- Compare your current medication costs on different plans
- Where you get your medication — in person or online pharmacies
- Drug tiers and coverage rules, such as prior authorization and step therapy
- How much you’ll pay out of pocket
- Original Medicare with Part D or Medicare Advantage with Part D
If you’ve already signed up for a Part D plan, an annual Medicare Part D review can keep your medications within your budget and in network. Every year, Part D plans may change covered drug lists and pharmacies, medications can change tiers, and premiums go up. I can help review all the Medicare Insurance Plans that are available to you and determine what’s best for your situation.