I’ve read online about a Medicare Part D plan covering prescriptions. What else does Medicare Part D cover? Thanks for your website and information; it’s very helpful!
Medicare Part D covers most “retail” prescription drugs. I’m referring to a stand-alone Medicare Part D Prescription Drug Plan (PDP) in this blog post. This is different from a Medicare Advantage plan with a Part D benefit embedded within it, which is technically Medicare Part C, and a “combo” product which you can read about in other blog posts. I agree; it gets confusing because most Medicare Advantage plans have Part D embedded into it (MAPD), but some do not (Medicare Advantage-Only Plans or, MA-Only)
What is a Medicare PDP?
You’ll hear people refer to this as a Medicare Part D Prescription Drug Plan, a PDP, or a Medicare Part D drug plan—all sorts of things. Think of this as the prescription drug card you show at the pharmacy counter or use when those same pharmacies mail you prescriptions.
Some prescription drugs are covered under Medicare Part B, but those are generally administered in the hospital or an outpatient facility, like chemotherapy or dialysis drugs. Some drugs are covered under Part A but usually only when you’re in a Skilled Nursing Facility or during a hospital stay. Either way, your month-to-month retail prescription drugs (high blood pressure, cholesterol, etc.) are covered under Medicare Part D.
Recent studies show that about 19% of the Medicare population buy a stand-alone Medicare Part D Prescription Drug Plan alongside Original Medicare—between 30-40% of people combine this with a Medicare supplement plan. Monthly premiums can vary from as low as $8 to as high as over $100, depending on the company, the number of drugs covered, and the plan design which you can find on my website. Most people pick a plan between $8 and $30 per month.
Medicare sets a “standard” or “minimum” Medicare Part D Prescription Drug Plan design for insurance companies to offer. Many offer plans that cover the gaps outlined below, usually for a higher premium.
Remember, you’d generally have to buy a stand-alone Medicare Part D Prescription Drug Plan (PDP) if you’re either a) “Bare with Medicare” or b) plan on buying a Medigap or Medicare Supplement plan.
Unlike Original Medicare Parts A and B, you don’t get Medicare Part D automatically (unless your annual income is below about $15,000 for individuals and $30,000 for couples), and you can’t sign up for this the same way you did for Medicare Part A or Part B. Nor can you sign up for it through Social Security. That’s because Medicare Part D Prescription Drug Plans are only sold by insurance companies. These insurance companies are essentially sub-contractors for Medicare. The premium and benefits are generally good for an entire calendar year when you buy one.
Do I Need to Have Medicare Part A or B to Purchase Medicare Part D Prescription Drug Plan?
If you want to buy a Medicare Part D Prescription Drug Plan, you must also have Original Medicare Part A or B. A lot of authors, reporters, and bloggers get this one wrong. You don’t have to have both A and B—just one of them. Of course, if you have both, you’re fine too.
When you buy a Medicare Part D Prescription Drug Plan (explained in Chapters Eight and Nine of my book Prepare for Medicare), you’ll be faced with many options. By my last count, every state has at least twenty-five Medicare Part D Prescription Drug Plan options to choose from. Don’t worry—I have the “prescription” to make it super easy for you to narrow down your choices and buy one.
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Author Bio Matt Feret is the author of the Prepare for Medicare book series and launched prepareformedicare.com to help people get objective answers to questions about Medicare. Matt is also the host of The Matt Feret Show. He has held leadership roles at numerous Fortune 500 Medicare health insurers in sales, marketing, operations, product development, and strategy for over two decades.