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How Does Medicare Part D Fit Together with Medicare Part A, Medicare Part B, and Medicare Part C?

 What is Medicare Part D?
 Medicare Part D Prescription Drug Plan (PDP) coverage is a voluntary program developed to help Medicare recipients deal with the rising cost of prescription medications. By paying a monthly premium (anywhere from $10 to around $156), you will be able to purchase most prescription medication at a lower price (sometimes even at no cost - $0 for generics).
  • Medicare Part A - pays for inpatient hospital, skilled nursing facility, and some home health care.
  • Medicare Part B - covers Medicare eligible physician services, outpatient hospital services, certain home health services, and durable medical equipment.
  • Medicare Part C - or Medicare Advantage plans (previously Medicare+Choice), make available Medicare-covered health care services through a Medicare private health plan, such as an HMO, PPO or Private Fee for Services (PFFS) plan.



Who ie eligible for Medicare Part D?

If you are entitled to Medicare benefits under Medicare Part A or enrolled in Medicare Part B; and you reside in the service area of the Medicare prescription drug plan - you are eligible for the Medicare Part D program.

Usually Medicare is available to people 65 years old and older, people who are under 65, but qualify for Medicare coverage, and people with End Stage Renal Disease (kidney failure).




How does Medicare Part A work?

Medicare Part A: pays for inpatient hospital, skilled nursing facility, and some home health care. For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (in 2019 the deductible = $1364) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.

Medicare Part A premiums are charged on the basis of how many quarters of Medicare-covered employment. In fact, most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment. For people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment, the Medicare Part A premium is $437 per month.
  • Medicare Part A will cover your prescription medications that you need during your Medicare-covered hospital or skilled nursing facility stay.



How does Medicare Part B work?

Medicare Part B: covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment. The Beneficiary pays 20% of the Medicare-approved amount for services after meeting the $185 deductible.

The 2019 monthly premium for Medicare Part B =$135.5 per month. However, 3.5 percent of Medicare beneficiaries will only pay their Part B premium amount from last year, plus a cost-of-living increase.

Click here to read the CMS Press Release on the 2019 premiums and deductibles.

  • Medicare Part B will cover your prescription medications administered by your physician or dialysis facility, as well as some of your outpatient prescription drugs.



I am enrolled in a Medicare Advantage Plan (Medicare Part C), can I also enroll in a Medicare Part D plan?

Probably not - Always check with your Medicare plan administrator ...
 Medicare Part C, also known as a Medicare Advantage plan (previously Medicare+Choice), makes available Medicare-covered health care services through a Medicare private health plan, such as an HMO, PPO or Private Fee for Services plan. There are two variations of Medicare Advantage Plans, those with (MA-PD) and those without prescription drug coverage (MA). If you are enrolled in a Medicare Advantage plan that includes prescription drug coverage (MA-PD), you usually can not enroll in a Medicare Part D Prescription Drug Plan, unless you are a member of a Private Fee-for-Service MA Plan (PFFS) a Medical Savings Account MA Plan (MSA), or a 1876 Cost Plan.

» Click here to review 2019 Medicare Advantage Plans.
» Click here to review 2019 Stand-Alone Medicare Prescription Drug Plans.



How can I choose between a stand-alone Medicare Part D plan (PDP) and a Medicare Advantage plan that includes prescription drug coverage (MAPD)?

Medicare prescription drug coverage is available through either stand-alone Medicare Part D prescription drug plans (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs).

Choosing how you receive Medicare drug coverage ultimately depends on your situation and personal preferences - and whether you need only prescription drug coverage or you wish to have prescription drug coverage and additional healthcare coverage.

To help you make a decision, you might want to examine these two types of Medicare plan options based on:
  • Coverage - Do you only need drug coverage? Do you already have a Medicare Supplement or other Medical insurance? You cannot use a Medicare Advantage plan with a Medicare Supplement.  If you have healthcare through your employer, you probably do not want to enroll into a PDP or an MAPD (or risk losing your employer coverage).

  • Complexity - If you choose an MAPD, ask whether your drugs, pharmacies, doctors, specialists, hospitals all included within the plan’s coverage or network? If you rely on a certain group of healthcare providers, you may find that they are not included in your plan’s network - and you will need to have approval to go outside of the plan's network - and may pay more for out-of-network services.
  • Availability - Is there a Medicare Advantage plan available in your Service Area (most Medicare Advantage plans are found in population-dense areas)?   Is a PDP the only drug plan alternative available for you?  Do you have ESRD (kidney failure) that would keep you from enrolling in a MAPD?

  • Cost - Are you healthy and looking to avoid the late-enrollment premium penalty?  If so, you may wish to just join a $0 premium Medicare Advantage plan (if available) that includes drug coverage (MAPD).   If you are unhealthy or have chronic health issues, a Medicare Advantage plan’s Maximum out of Pocket (MOOP) limit may help contain your annual medical costs (albeit to around $6,700, depending on the plan).
Need to read a little more about Medicare Advantage plans and stand-alone Medicare Part D plans?

Please see our Frequently Asked Questions (FAQs):



Can I be enrolled in more than one Medicare Part D plan?

No ... You may be enrolled in only one Medicare Part D prescription drug plan at a time.

Many people are confused with the enrollment process and enroll in more than one Part D plan (thinking that they can use both plans). If you have enrolled in two stand-alone Medicare Part D plans, the most recent enrollment is probably effective and the first Part D plan enrollment will be canceled by your re-enrollment. If you are not sure if you are enrolled in a plan, contact the plan first before re-enrolling. When in doubt, you can also telephone Medicare (1-800-633-4227) and ask about your Medicare plan enrollment.

Remember, your Medicare plan will need about 10 business-days to process your enrollment, so make sure you give your Medicare plan a little time before checking on whether your enrollment was effective.
Medicare Part D and VA drug benefits

VA prescription drug coverage can work together with a Medicare Part D plan.

If you are entitled to VA health benefits, your coverage will not change when you are eligible for Medicare.  If you decide that VA drug coverage meets your prescription needs, you can choose not to join a Medicare drug plan.

VA prescription drug coverage is considered creditable drug coverage, which means it is at least as good as Medicare drug coverage.  If you decide you want to join a Medicare drug plan after you are first eligible, you won't have to pay a late enrollment penalty if you later decide to join a Medicare Part D plan.

Please remember, after the close of your Initial Enrollment Period that if you want to join a Medicare drug plan, you must wait for a valid enrollment period. Again, you will not have to pay a late enrollment penalty with VA drug coverage.


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Tips & Disclaimers
  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
  • Medicare has neither reviewed nor endorsed the information on our site.
  • We provide our Q1Medicare.com site for educational purposes and strive to present unbiased and accurate information. However, Q1Medicare is not intended as a substitute for your lawyer, doctor, healthcare provider, financial advisor, or pharmacist. For more information on your Medicare coverage, please be sure to seek legal, medical, pharmaceutical, or financial advice from a licensed professional or telephone Medicare at 1-800-633-4227.
  • We are an independent education, research, and technology company. We are not affiliated with any Medicare plan, plan carrier, healthcare provider, or insurance company. We are not compensated for Medicare plan enrollments. We do not sell leads or share your personal information.
  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDP-Compare.com and MA-Compare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
  • Limitations, copayments, and restrictions may apply.
  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.
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