Part D Plans: Prescription Coverage for Medicare Beneficiaries

What Are Medicare Part D Plans

Medicare Part D is the prescription drug program that helps you pay for your medications. The structure of these plans is regulated by Medicare, so the basic structure of all Part D plans will be the same, however plans are offered by private insurance companies. And thus, Part D plan benefits will vary by company and plan.

Who Can Enroll in a Medicare Part D Plan

You will have to enroll in Part D, as well as purchase a plan if you want to take advantage of the benefits. Enrolling when you become eligible is important, as you will be assessed a late enrollment penalty if you do not. The penalty will be added to your monthly premium, and typically continue for as long as you are enrolled.

To be eligible to enroll in a Part D plan, you must:

Be entitled to Medicare Part A and/or enrolled in Part B
Live in the service area of a Medicare Part D Prescription Drug Plan
Be a U.S. citizen or lawfully present in the United States

How To Enroll

Many Medicare Advantage plans include Part D benefits, therefore enrolling in a MAPD (Medicare Advantage Part D) plan would offer you this coverage and health insurance all under one plan.

Should you decide to enroll in a Medicare Advantage plan without part D coverage, you will want to take advantage of a stand alone Part D plan. Stand alone Part D plans are completely separate from your health insurance, and can be paired with your Medicare supplement.

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How Medicare Part D Plans Work

Part D prescription plans have changed significantly for 2027. The 2027 Part D plans no longer have the Donut hole!

For 2027, Part D prescription plans will have three stages:

Deductible: If a plan has a prescription drug deductible, you will pay the full cost of the prescription until you reach the deductible amount. Then you will move into the Initial Coverage stage.
Initial Coverage: Members will pay the copays and coinsurance, according to their plan. The plan will pay the rest. Once the member (and others on their behalf) have paid a combined total of $2400, they move to the Catastrophic Coverage stage.
Catastrophic Coverage: Members won’t pay anything for their Part D covered prescriptions for the rest of the year.

What Prescriptions Are Covered

Each Part D Plan will have its own list of covered drugs (a formulary). Medicare mandates that Part D plans cover at least two drugs per class, so you should be able to find a suitable plan that fits your needs. Interestingly, you can even ask you plan to make an exception to cover drugs not on the formulary. You should speak with a Florida Medicare Advantage.com Advisor if you have must-have prescriptions. Your advisor can review your prescriptions to let you know what prescriptions are covered (and how much they would cost).