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Medicare 
Prescription Insurance
(Part D)

Medicare Prescription Insurance (Part D)

Medicare Part D is the prescription drug benefit that covers most outpatient prescription drugs. Part D coverage is offered through private insurance companies that are approved and contracted by Medicare.

 

There are (2) primary ways to get Medicare drug coverage under Part D:

 

  1. Stand-alone Drug Plan with Original Medicare:  If you choose Original Medicare, you can purchase a stand-alone Medicare Part D prescription drug plan through a private insurance company.

  1. Bundled Drug Plan with Medicare Advantage:  If you enroll in a Medicare Advantage (Part C) plan, most policies will include prescription drug coverage.

 

Part D plans must include at least two drugs from most categories and must cover all drugs available in the following categories (a drug category is a group of drugs that treat the same symptoms or have similar effects on the body):

  • Anticancer drugs (unless covered by Medicare Part B),

  • Antidepressants,

  • Antipsychotic medications,

  • Anticonvulsive treatments for seizure disorders,

  • HIV/AIDS treatments,

  • Immunosuppressant medications

 

Part D plans must also cover vaccines, including shingles shots, which are not covered by Medicare Part B.  (The annual flu shot, pneumococcal, and COVID-19 vaccines are covered by Medicare Part B.)

 

There are some drugs that are explicitly excluded from Medicare coverage by law, including drugs for:

  • Weight loss or weight gain

  • Cough and colds symptomatic relief

  • Cosmetic purposes

  • Fertility

  • Hair growth

  • Over-the-counter medications

  • Sexual or erectile dysfunction

  • Vitamins and minerals

 

Medicare Part D has out-of-pockets cost such as premiums, deductibles, copayments and coinsurance. Monthly premiums and deductible amounts can vary from plan to plan.  Additionally, higher income earners may be required to pay an additional monthly charge.

 

It is important to check the plan’s formulary, or list of covered drugs, to make sure your prescriptions are covered and find out about your out-of-pocket costs (premiums, deductibles, coinsurance, copays), as well as which pharmacies might be preferred and provide the lowest out-of-pocket costs.

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