{"id":51892,"date":"2022-06-24T17:25:17","date_gmt":"2022-06-24T21:25:17","guid":{"rendered":"https:\/\/www.singlecare.com\/blog\/?p=51892"},"modified":"2025-05-23T14:15:08","modified_gmt":"2025-05-23T18:15:08","slug":"what-is-medicare-part-d","status":"publish","type":"post","link":"https:\/\/www.singlecare.com\/blog\/what-is-medicare-part-d\/","title":{"rendered":"What is Medicare Part D?"},"content":{"rendered":"<p><span style=\"font-weight: 400;\">Prescriptions can be expensive, and that\u2019s stressful if you\u2019re having trouble affording them. A health insurance plan that covers some of your medication costs can help make staying healthy a little easier. Medicare Part D prescription drug benefits can help.<\/span><\/p>\n<h2><span style=\"font-weight: 400;\">What is Medicare Part D?<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Medicare Part D is provided by the federal government and is an optional part of Medicare that helps cover prescription drug costs. Part D is offered through private insurance companies that many people on Medicare choose to help offset drug costs. You must be eligible for Medicare to get Medicare Part D coverage.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Medicare beneficiaries can enroll in a stand-alone Medicare Part D prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug plan (MAPD) to get prescription drug coverage. Note: Medicare Advantage would change the way a consumer receives Parts A and B, too.<\/span><\/p>\n<p><b>RELATED: <\/b><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-vs-medicare-advantage\/\"><b>Medicare Part D vs. Medicare Advantage<\/b><\/a><\/p>\n<p><span style=\"font-weight: 400;\">Not all Medicare Part D drug plans have a deductible, but for those that do have a deductible, the beneficiary must meet the deductible before the plan starts covering any medication costs. Medications that the insurance company covers can be purchased for a copay or coinsurance after the deductible is met. The insurance company covers the remaining costs.<\/span><\/p>\n<table class=\" singlecare-table\">\n<thead>\n<tr>\n<th>\n<h2><span class=\"title\">Medicare Part D<\/span><\/h2>\n<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><a href=\"#coverage\"><span style=\"font-weight: 400;\">Coverage<\/span><\/a><\/td>\n<td><span style=\"font-weight: 400;\">Prescription medications<\/span><\/td>\n<\/tr>\n<tr>\n<td><a href=\"#cost\"><span style=\"font-weight: 400;\">Cost<\/span><\/a><\/td>\n<td><span style=\"font-weight: 400;\">Costs will depend on the plan you choose. Those with higher incomes may also pay higher premium prices.\u00a0<\/span><\/td>\n<\/tr>\n<tr>\n<td><a href=\"#eligibility\"><span style=\"font-weight: 400;\">Eligibility<\/span><\/a><\/td>\n<td><span style=\"font-weight: 400;\">If you\u2019re eligible for Medicare, you\u2019re eligible for Medicare Part D. Those eligible for Medicare are typically people aged 65 or older and younger people with disabilities or End-Stage Renal Disease.<\/span><\/td>\n<\/tr>\n<tr>\n<td><a href=\"#enrollment\"><span style=\"font-weight: 400;\">Enrollment<\/span><\/a><\/td>\n<td><span style=\"font-weight: 400;\">Enroll using the <\/span><a href=\"https:\/\/www.medicare.gov\/plan-compare\/#\/\" target=\"_blank\" rel=\"noopener\"><span style=\"font-weight: 400;\">Medicare Plan Finder<\/span><\/a><span style=\"font-weight: 400;\"> or through the specific plan&#8217;s website.<\/span><\/td>\n<\/tr>\n<tr>\n<td><a href=\"#considerations-when-choosing\"><span style=\"font-weight: 400;\">Considerations when choosing a plan<\/span><\/a><\/td>\n<td>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you mostly take generic drugs or brand-name prescriptions? If you take brand-name drugs, ask a doctor if you can switch to a generic, which is more likely covered by Medicare and cheaper overall.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you take a specific drug? Check the plan\u2019s drug formulary to make sure it\u2019s covered and with as few restrictions as possible.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you want or need additional services that Original Medicare does not provide? A <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-medicare-advantage\/\"><span style=\"font-weight: 400;\">Part C plan<\/span><\/a><span style=\"font-weight: 400;\"> that includes drug coverage may be better for you.<\/span><\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h2 id=\"coverage\"><span style=\"font-weight: 400;\">Coverage<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/what-drugs-are-covered-by-medicare-part-d\/\"><span style=\"font-weight: 400;\">prescription drugs covered by Medicare Part D plans<\/span><\/a><span style=\"font-weight: 400;\"> will vary based on what each individual insurance carrier covers.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A Medicare Part D plan generally covers at least two drugs from every drug category. Plans are also required to cover almost every drug from the following classes:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Antipsychotics<\/b><span style=\"font-weight: 400;\">: These drugs are prescribed to help manage psychosis. Examples of commonly prescribed antipsychotics include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/haldol-decanoate\"><span style=\"font-weight: 400;\">Haldol (haloperidol)<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/risperdal\"><span style=\"font-weight: 400;\">Risperdal (risperidone)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Antidepressants<\/b><span style=\"font-weight: 400;\">: These drugs help treat depressive and anxiety disorders for many people. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/effexor-xr\"><span style=\"font-weight: 400;\">Effexor XR (venlafaxine)<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/prozac\"><span style=\"font-weight: 400;\">Prozac (fluoxetine)<\/span><\/a><span style=\"font-weight: 400;\"> are two commonly prescribed antidepressants.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Anticonvulsants<\/b><span style=\"font-weight: 400;\">: This group of drugs consisting of pharmacological agents helps those who experience epileptic seizures. Examples of anticonvulsants that may be covered by a Medicare Part D plan include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/keppra\"><span style=\"font-weight: 400;\">Keppra (levetiracetam)<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/lamictal\"><span style=\"font-weight: 400;\">Lamictal (lamotrigine)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Immunosuppressants<\/b><span style=\"font-weight: 400;\">: These drugs reduce the strength of the body\u2019s immune system, which is sometimes required for organ transplants or to treat autoimmune diseases. <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/prednisone\"><span style=\"font-weight: 400;\">Prednisone<\/span><\/a><span style=\"font-weight: 400;\"> medications, like Deltasone and Orasone, are examples of commonly prescribed immunosuppressants.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Cancer drugs<\/b><span style=\"font-weight: 400;\">: Medicare prescription drug coverage does include some cancer drugs. It\u2019s important to talk with your healthcare provider and insurance carrier to make sure the drug you need is covered before enrolling in a prescription drug benefit. Examples of commonly prescribed cancer drugs include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/avastin\"><span style=\"font-weight: 400;\">Avastin (bevacizumab)<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/revlimid\"><span style=\"font-weight: 400;\">Revlimid (lenalidomide)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>HIV\/AIDS drugs<\/b><span style=\"font-weight: 400;\">: A Medicare Part D plan will cover some prescription medications for HIV\/AIDS. Some examples of these types of drugs include <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/truvada\"><span style=\"font-weight: 400;\">Truvada (emtricitabine-tenofovir)<\/span><\/a><span style=\"font-weight: 400;\">, <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/norvir\"><span style=\"font-weight: 400;\">Norvir (ritonavir)<\/span><\/a><span style=\"font-weight: 400;\">, and <\/span><a href=\"https:\/\/www.singlecare.com\/prescription\/isentress\"><span style=\"font-weight: 400;\">Isentress (raltegravir)<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">It is more likely for generic drugs to be covered by Medicare Part D; however, brand-name drugs without a generic alternative may also be covered by Medicare Part D.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Drugs are placed into <\/span><a href=\"https:\/\/www.medicare.gov\/drug-coverage-part-d\/what-medicare-part-d-drug-plans-cover\"><span style=\"font-weight: 400;\">tiers<\/span><\/a><span style=\"font-weight: 400;\"> by Medicare Part D plans, and costs will vary by tier. For example, brand-name drugs may be placed into higher tiers that have a higher copay or coinsurance.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">One thing to know about Medicare Part D costs is that it doesn\u2019t cover over-the-counter medications, prescription vitamins, and certain other medications. Talking with a healthcare provider and reviewing your plan options annually is the best way to determine if your Medicare Part D plan is the right plan for you based on your individual medical needs.<\/span><\/p>\n<h2 id=\"cost\"><span style=\"font-weight: 400;\">Cost<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Every Part D plan has its own premium, deductible, and copays\/coinsurance <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-formulary\/\"><span style=\"font-weight: 400;\">based on the plan\u2019s formulary<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Beneficiaries may pay a monthly premium to their insurance carrier. The <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-costs\/\"><b>monthly premium<\/b><\/a><span style=\"font-weight: 400;\"> for those with Medicare Part D varies depending on the plan. People with higher incomes may pay higher costs for their Part D premium. You can choose to have the costs of your Part D premium automatically deducted from your Social Security check, but it\u2019s almost always better to pay the plan directly.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If the insurance company requires a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-deductible\/\"><b>deductible<\/b><\/a><span style=\"font-weight: 400;\">, the beneficiary will pay full price for every covered drug until the deductible amount is met. There are limits to the amount of a deductible. However, not all Part D plans have a deductible.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">After the deductible is met, the beneficiary will pay a <\/span><b>copay or coinsurance <\/b><span style=\"font-weight: 400;\">for every covered prescription. Copay amounts and coinsurance rates vary by plan. This stage is called the initial coverage period.<\/span><\/p>\n<p><b>Catastrophic coverage<\/b><span style=\"font-weight: 400;\"> is the final stage of Medicare Part D coverage. It\u2019s reached after the beneficiary alone pays a certain amount in total out-of-pocket costs, <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/compare-medicare-part-d-plans\/\"><span style=\"font-weight: 400;\">which changes each year<\/span><\/a><span style=\"font-weight: 400;\">. After the beneficiary meets the out-of-pocket threshold, they\u2019ll pay nothing for their covered medications through the end of the year.<\/span><\/p>\n<p><b>How to save on Part D costs:\u00a0<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">People on Medicaid or those who qualify for <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-extra-help\/\"><span style=\"font-weight: 400;\">Extra Help<\/span><\/a><span style=\"font-weight: 400;\"> (a low-income subsidy) may pay significantly lower costs and have cost-sharing under Part D.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.singlecare.com\/blog\/what-is-medigap\/\"><span style=\"font-weight: 400;\">Medigaps<\/span><\/a><span style=\"font-weight: 400;\">, or Medicare supplement insurance, may also help cover some of these costs.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">When Medicare does not cover a drug or if your prescription copay with Medicare is still too high, <\/span><a href=\"https:\/\/www.singlecare.com\/medicare\"><span style=\"font-weight: 400;\">check the price with a SingleCare coupon<\/span><\/a><span style=\"font-weight: 400;\">. SingleCare is free and can be used instead of Medicare.<\/span><\/li>\n<\/ul>\n<h2 id=\"eligibility\"><span style=\"font-weight: 400;\">Eligibility<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">If you\u2019re 65 years of age or older, you <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-eligibility\/\"><span style=\"font-weight: 400;\">qualify for Medicare coverage<\/span><\/a><span style=\"font-weight: 400;\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">It is also available to younger people who have disabilities and those who have amyotrophic lateral sclerosis (ALS) or End-Stage Renal Disease and are on dialysis.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Everyone eligible for Medicare is also eligible for Medicare Part D. However, you\u2019ll need to be enrolled in either Part A and\/or Part B to receive Medicare Part D services.\u00a0<\/span><\/p>\n<h2 id=\"enrollment\"><span style=\"font-weight: 400;\">Enrollment<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">It\u2019s easy to compare plan options on medicare.gov if you\u2019re interested in signing up for a Medicare prescription drug plan. Call 1-800-Medicare to speak to a counselor if you need assistance.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Sometimes, individuals may be automatically enrolled in Medicare, and other times, you\u2019ll need to sign up yourself.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The Initial Enrollment Period for those new to Medicare and who are turning 65 years old includes the three months before, the month of, and the three months following their birthday.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The annual <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-open-enrollment\/\"><span style=\"font-weight: 400;\">Open Enrollment Period<\/span><\/a><span style=\"font-weight: 400;\"> runs from Oct. 15 to Dec. 7. You can switch plans to one that better suits your needs during open enrollment.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Enrollees with Medicare Advantage plans may be able to switch plans during the Medicare Advantage Open Enrollment Period, which is from Jan. 1 to Mar. 31.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you don\u2019t enroll within these timeframes, you may pay a late enrollment penalty unless you qualify for Extra Help. It\u2019s a good idea to mark the deadlines on your calendar and visit medicare.gov to see if you qualify for a <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/get-started-with-medicare\/get-more-coverage\/joining-a-plan\/special-enrollment-periods\"><span style=\"font-weight: 400;\">Special Enrollment Period<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h2 id=\"considerations-when-choosing\"><span style=\"font-weight: 400;\">How to choose the best Medicare Part D plan<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">The best Medicare Part D plan will vary between each enrollee and their specific needs.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">\u201cIt\u2019s important to consider what maintenance medications you\u2019re taking regularly and where you like to fill your prescriptions since a plan\u2019s preferred pharmacy will generally offer you the best price,\u201d said <\/span><a href=\"https:\/\/www.linkedin.com\/in\/kateashford\"><span style=\"font-weight: 400;\">Kate Ashford<\/span><\/a><span style=\"font-weight: 400;\">, Medicare specialist at NerdWallet. \u201cMedicare\u2019s plan comparison tool allows you to input your drugs and pharmacies so you can do some comparisons on plans in your area. A surprising number of people don\u2019t do this, but choosing the right drug plan can save you a lot of money if you take regular prescriptions.\u201d\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Although we cannot attribute any plan to being the \u201cbest,\u201d Medicare consumers should consider several factors when choosing a plan, such as:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Which plan covers the majority (if not all) of your prescriptions?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are there any restrictions, such as <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/step-therapy\/\"><span style=\"font-weight: 400;\">step therapy<\/span><\/a><span style=\"font-weight: 400;\"> and <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/prior-authorization\/\"><span style=\"font-weight: 400;\">prior authorization<\/span><\/a><span style=\"font-weight: 400;\">?\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">If you take a brand-name drug that is not covered, can you switch to a generic, or do you qualify for an exception?<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you want to avoid limited provider networks for your health (non-drug) coverage? A stand-alone Part D plan with <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/original-medicare-vs-medicare-advantage\/\"><span style=\"font-weight: 400;\">Original Medicare may be preferable to a Medicare Advantage plan<\/span><\/a><span style=\"font-weight: 400;\"> with drug coverage.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Do you want or need additional healthcare services that Original Medicare does not provide? A Part C plan that includes drug coverage may be better for you than Original Medicare with a standalone Part D plan.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Are you not interested in a prescription drug plan at this time? If not, you may want to still consider ensuring you have creditable drug coverage while you are eligible for Medicare. Creditable drug coverage is a prescription drug plan that\u2019s expected to pay as much or more than the standard Medicare Part D plan. If you do not sign up for Part D during initial enrollment and you do not have creditable drug coverage, you may have to pay a <\/span><a href=\"https:\/\/www.singlecare.com\/blog\/medicare-part-d-penalty\/\"><span style=\"font-weight: 400;\">late enrollment penalty<\/span><\/a><span style=\"font-weight: 400;\"> if you choose to enroll in Part D later.\u00a0<\/span><\/li>\n<\/ul>\n<p id=\"coverage\"><span style=\"font-weight: 400;\">The best-rated plans will vary from state to state, so use the <\/span><a href=\"https:\/\/www.medicare.gov\/plan-compare\/#\/?lang=en&amp;year=2022\"><span style=\"font-weight: 400;\">Medicare Plan Finder tool<\/span><\/a><span style=\"font-weight: 400;\"> provided by the Centers for Medicare &amp; Medicaid Services and put in your specific location to see the ratings of the plans available to you.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prescriptions can be expensive, and that\u2019s stressful if you\u2019re having trouble affording them. A health insurance plan that covers some of your medication costs can help make staying healthy a little easier. Medicare Part D prescription drug benefits can help. What is Medicare Part D? Medicare Part D is provided by the federal government and [&hellip;]<\/p>\n","protected":false},"author":15,"featured_media":52295,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[2],"tags":[15],"coauthors":[8861],"class_list":["post-51892","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-company","tag-medicare","wpautop"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.4 (Yoast SEO v27.4) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>What is Medicare Part D? | SingleCare<\/title>\n<meta name=\"description\" content=\"Medicare Part D is optional prescription drug insurance. 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