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Home / Medicare Part D Plans / Medicare Part D Prescription Drug Coverage
Medicare Part D Plans

Medicare Part D Prescription Drug Coverage

By:Michael Quinn Published onMay 6, 2020August 23, 2023 Updated onAugust 23, 2023

Medicare Part D

Medicare Part D is the United States federal drug benefit program.  Part D is designed to help anyone on Medicare with their drug coverage.

In this article we’ll discuss:
  • Medicare Part D
  • who is eligible for medicare part d?
  • how do i get medicare part d?
  • can you sign up for medicare part d anytime?
  • how much does medicare part d cost?
  • Part D plans have 4 Stages
  • Frequently Asked Questions
medicare part d

who is eligible for medicare part d?

If you have either Medicare Part A or Medicare Part B, you will be eligible for Medicare Part D. There are no exams that are required to qualify for Part D. You can’t be denied coverage because of preexisting conditions or if you already use prescription drugs.

how do i get medicare part d?

Part D plans are sold through private insurance companies. These insurers have contracts with the federal government which allows them to sell their drug plans to consumers like you. Part D plans are not sold by the government. How do you find the right Part D plan? You can use a broker or go directly to Medicare.gov.  

can you sign up for medicare part d anytime?

Most people should sign up for their Part D when they are eligible to enroll in Original Medicare. You are only allowed to sign up for Part D during specific enrollment periods.

These enrollment periods include:

  • Initial Enrollment Period: When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B.
  • Special Enrollment Period: The following are the most common Special Enrollment Period scenarios. However, there are more ways you can qualify. Let’s look at the most common situations:
    • You already have a Medicare Part D plan and change where you live.
    • You lose or drop your employer health insurance coverage.
    • Your plan changes its contract with Medicare. For example, Medicare terminates your current plan’s contract or Medicare doesn’t renew the contract.
  • Annual Election Period: Medicare’s annual election period is October 15th – December 7th. During this time, Medicare beneficiaries can change or sign up for a Part D drug plan.

how much does medicare part d cost?

The price that you’ll ultimately pay will often depend on your medications and what stage you’re in. 

Part D plans have 4 Stages

You may end up paying a different price for the exact same medication depending on the phase of coverage that you’re in during the year.

1. Deductible

Some drug plans have a deductible. If so, you’ll pay the full price for your medications until your deductible amount is satisfied. Your price boils down to what your plan has negotiated with the drug manufacturer. This full price may be lower than what you would have to pay retail at your pharmacy.

2. Initial coverage period

This refers to your share of drug costs for each prescription that is either a percentage or a flat Copayment. The majority of Part D plans have several Tiers of copays. These copays increase in cost from the cheapest generic drugs to preferred and non-preferred brandname drugs and finally to higher-cost specialty drugs.

3. Coverage gap

The coverage gap (frequently called The Medicare Donut hole) is the gap inside of your Medicare Part D drug plan. It’s the time when your Part D drug costs can be more expensive than they were before you reaching the coverage gap (donut hole). During this phase, the drug manufacturer covers 75% of the cost of your medications, and you are responsible for the remaining amount. 

4. Catastrophic level of coverage

Your share of each of your medications is approximately no higher than 5% of the cost of the medication. The price for your drugs may also be different if you receive Extra Help. The price could be different if you have additional coverage from another source like a retiree drug benefit or help from your state pharmacy assistance program.

Frequently Asked Questions

Is Medicare Part D Mandatory?

You can change to a new Medicare Part D drug plan by signing up for another drug plan during one of these times:
*Initial Enrollment Periods for Part D
*Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage.
*Medicare Advantage Open Enrollment Period.

How To Change Medicare Part D Plan?

You can change to a new Medicare Part D drug plan by signing up for another drug plan during one of these times.
Initial Enrollment Periods for Part D
Open Enrollment Period for Medicare Advantage and Medicare prescription drug coverage.
Medicare Advantage Open Enrollment Period.

When Did Medicare Part D Penalty Start?

If you delay signing up for a Medicare Part D plan you may end up paying a penalty when you begin your plan. This penalty will stay and remain as long as you have Part D drug coverage.

How To Cancel Medicare Part D?

You won’t need to cancel your old Medicare Part D drug plan, because your old Part D plan will terminate when your new Part D plan begins.

Michael Quinn
Website

Michael Quinn is a seasoned Medicare insurance expert and licensed agent dedicated to simplifying the complexities of healthcare coverage. With over a decade of experience, he is a trusted advisor known for his compassionate guidance and commitment to empowering individuals. As the Cofounder of REMEDIGAP in 2013, Michael offers unbiased resources and personalized support to assist clients in making informed decisions.
His expertise has been recognized on reputable platforms such as USA Today and Nerdwallet, solidifying his reputation as a reliable and knowledgeable industry leader. With a Master's Degree in Communicative Disorders, Michael combines strong communication skills with a genuine passion for positively impacting lives through tailored insurance solutions.

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Content Editor

Michael Quinn

Michael Quinn is a seasoned Medicare insurance expert and licensed agent dedicated to simplifying the complexities of healthcare coverage. With over a decade of experience, he is a trusted advisor known for his compassionate guidance and commitment to empowering individuals. As the Cofounder of REMEDIGAP in 2013, Michael offers unbiased resources and personalized support to assist clients in making informed decisions. His expertise has been recognized on reputable platforms such as USA Today and Nerdwallet, solidifying his reputation as a reliable and knowledgeable industry leader. With a Master’s Degree in Communicative Disorders, Michael combines strong communication skills with a genuine passion for positively impacting lives through tailored insurance solutions.

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Written by Michael Quinn
Licensed Broker, REMEDIGAP Founder

Fact Checked by Joann Quinn
Chief Compliance Officer

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As a licensed insurance broker, REMEDIGAP upholds the principles of integrity in our editorial standards and ensures transparency in how we receive compensation from our insurance partners.

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Michael Quinn

Michael Quinn

Licensed Agent, REMEDIGAP Founder

Michael Quinn is a nationally licensed insurance expert with over a decade of experience and has helped over 1000 clients with their Medicare Supplement needs. Michael has been consulted as an expert insurance source for dozens of high-profile websites such as USA Today, Yahoo.com, NerdWallet, Bankrate, ThinkAdvisor, The Epoch Times, and many more.

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Joann Quinn

Licensed Agent, REMEDIGAP Founder

Joann Quinn is a nationally licensed insurance expert with over a decade of experience and has personally helped thousands of clients with their Medicare Supplement questions and needs. Joann has been consulted as a Medicare expert for high-profile websites and runs a very popular YouTube channel that focuses on understanding the complexities of Medicare.

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      Advantage Plans

      Also known as Medicare Part C

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