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What is Medicare Part D prescription drug coverage?

Medicare Part D helps cover prescription drug costs. Anyone who qualifies for Medicare can get it in one of two ways. The first is getting it as a stand-alone prescription drug plan. The second is by getting a Medicare Advantage plan (Part C) that includes prescription drug coverage. However you get it, Medicare drug plans are an important way to stay healthy while saving on costs.

 

What does Medicare Part D cover?

Medicare Part D plans cover certain prescription drugs. Long and short-term medications are both included. These drugs are listed in a drug formulary — a tiered list describing drugs and their costs. Drug tiers classify Part D drugs from lowest cost (starting at Tier 1) to highest cost. Our Aetna® Medicare Part D drug tiers are:

 

  • Tier 1 – Lower cost, preferred generic drugs
  • Tier 2 – Slightly higher cost, includes generics
  • Tier 3 – Higher cost, includes preferred brand prescription drugs
  • Tier 4 – Even higher cost brand name, includes non-preferred prescription drugs
  • Tier 5 – Highest cost prescription drugs, includes specialty drugs

 

Search for your drugs to find out if they’re covered

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How to choose a Medicare Part D plan

 

Think about your unique needs when choosing a Medicare plan. You may consider the following:

 

  • Check the drugs you need against the drugs covered by the plan. You’ll want to pick a plan that covers your drugs.
  • Understand the differences in prescription drug coverage. Not all coverage works the same across every available plan.
  • Compare Medicare Part D costs. Consider what you can afford against what you need from your plan.
 

How much does Medicare Part D cost?

Medicare Part D costs can vary. Generally, they include:

 

  • Monthly plan premium — This is a set amount you pay each month.
  • Part D deductible — This is the amount you pay out of pocket for covered drugs each year before your plan begins to pay. Your deductible resets at the beginning of each year.
  • Copayments — These are fixed amounts you pay at the pharmacy for covered drugs.
  • Coinsurance — This is a percentage of a drug’s cost that you pay at the pharmacy. If your coinsurance is 10% and a drug costs $100, you would pay $10.

 

What is Medicare Extra Help?

 

Need help paying for prescriptions? The Medicare Extra Help program can offer assistance  helps pay premiums, annual deductibles and copayments for prescription drug coverage (Part D payments. You may qualify if you:

 

  • Have Medicaid coverage (need-based coverage)
  • Are covering Part B premium costs through a state Medicaid program
  • Have Supplemental Security Income benefits
 

Learn more about Extra Help

 

Catastrophic coverage

There are three phases to Medicare drug coverage since the coverage gap phase (donut hole) was eliminated. These are the deductible phase, the initial coverage phase and the catastrophic coverage phase. The deductible phase is when you pay the full drug cost. Your plan has not begun to pay yet. It lasts until you pay the plan’s full deductible amount. After your deductible is paid, the initial coverage phase is when your plan pays for part of the covered drugs while you pay a copay or coinsurance. Finally, the catastrophic phase comes once you pay your deductible for the year and reach your plan’s limit for out-of-pocket costs. Once you reach this phase, you will have zero out-of-pocket costs until the end of the calendar year.

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How to sign up for Medicare Part D

You can enroll in Part D during specific Medicare enrollment periods:

  • Initial Enrollment Period

    Your Initial Enrollment Period includes the 3 months before you turn 65, the month you turn 65, and the 3 months after. If you have a qualifying disease or disability, this same time frame applies to the day you receive your diagnosis (3 months before your 65th birthday, month of and 3 months after).

  • Annual Enrollment Period

    This period lasts from October 15 to December 7 every year. During this time, you can switch to a Medicare Advantage plan from Original Medicare. You can also switch from a Medicare Advantage plan without a prescription drug plan to one that has it — or vice versa.

  • Special Enrollment Period

    This period is for people who end/lose employer medical coverage. The Special Enrollment Period lasts for 8 months, starting the month after you leave your job or lose your employer medical coverage.

  • Medicare Advantage Open Enrollment Period

    This period runs from January 1 to March 31 each year. If you have a Medicare Advantage plan, you can make a one-time switch to a different Medicare Advantage plan or to Original Medicare. You can also enroll in a Medicare prescription drug plan during this time.

 

If you do not sign up during any of these enrollment periods, you may be subject to penalties. Learn how to avoid late enrollment penalties when you sign up for Medicare Part D.

 

Still have questions? Learn more about Medicare enrollment periods.

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