A non-government resource for the Medicare community
Powered by Q1Group LLC
A non-government Medicare community resource

Medicare Part D? What is it? How do I do to get it? Who pays for it? How do I enroll?

Category: General Medicare Part D (PDPs and MAPDs)
Updated: May, 18 2023

The Medicare Part D prescription drug program provides prescription drug coverage through either stand-alone Medicare prescription drug plan (PDPs) or Medicare Advantage plans that include prescription drug coverage (MAPDs).

The prescription drug coverage is provided by private companies that contract with the Centers for Medicare and Medicaid Services (CMS).  These private companies then negotiate with drug suppliers or pharmacies for the retail price of the medications.

Actually, the retail prices of your Medicare Part D drugs can (and usually do) change throughout the year.  We update our Drug Finder (Q1Rx.com) and Formulary Browser (Formulary-Browser.com) with new retail drug pricing as the pricing information is released by Medicare.  But, retail drug prices vary, not only plan-to-plan, but also pharmacy-to-pharmacy for a given Medicare plan.  The data we show is always the average negotiated retail price across all pharmacies for a specific Medicare plan.

Each Medicare prescription drug plan will have a formulary or drug list including all prescription drugs that are covered by the Part D plan - and the formulary will show the price you will pay for coverage (for instance $60 for all Tier 3 Brand Name drugs or 25% co-insurance for all specialty drugs) - and the formulary will include usage restrictions (for instance, Quantity Limits such as only 30 tablets per 30-days, Prior Authorization, required Step Therapy ).

We strive to provide information for every Medicare Part D prescription drug plan in every state.  Here is a link to our Q1Medicare PDP-Finder to get started with Medicare Part D plan selection (just choose your state to view all Medicare Part D plans in your area:  PDPFinder.com

You will see a place on our Medicare Part D plan finder that will allow you to email the result to yourself or someone else.  Please note that, as part of our Privacy Policy, we never share your personal information with anyone.

Based on regular changes in drug prices or the availability of drugs, Medicare Part D plan providers will re-examine their plan designs (cost and coverage) each year and then submit the new plans for CMS approval.  Once approved, the Medicare plans are offered to the public during the annual Open Enrollment Period (October 15th through December 7th).

If you are enrolled in a Medicare Part D plan, and the plan is offered next year, and you make no choice during the annual Open Enrollment Period, you will be automatically, re-enrolled into the plan for another year - but your plan may have made changes to cost and coverage.  So, every year, you should be prepared to reevaluate your prescription needs and check to see if you are still enrolled in the most economical and convenient plan.  We have an online Medicare Part D plan comparison tool to help you see how your plan is changing each year: PDP-Compare.com

When you enroll in a Medicare Part D plan, you would be responsible for the cost of your Medicare Part D plan (premiums, deductibles, and cost-sharing) just like any insurance, unless you qualify for the Medicare Part D financial extra help program.  (If you qualify for Medicaid, then you automatically qualify for Extra Help or the Low-Income Subsidy).  Here is a link to more information on the Extra Help program:  https://q1medicare.com/PartD-Financial-Assistance-by-Medicaid.php

As noted, without some form of Financial Extra Help, your costs for a Medicare Part D plan would include a monthly premium, possibly an initial deductible (unless you join a Medicare Part D plan with a $0 deductible), and then you would pay a certain price for your covered medications.

If you have a higher income, you may be subject to IRMAA or the Income Related Monthly Adjustment Amount that means you will pay more for your monthly premiums based on your income level.  You can read more about IRMAA here:  Q1FAQ.com/539

Your Medicare Part D plan has up to four phases:
Based on the retail value of your medications, after you have purchased a certain amount of medications each year, you will enter the Donut Hole or Coverage Gap portion of your Medicare Part D plan where you are again responsible for the full cost of your medications.

However, the Donut Hole discount program was introduced to help people who reached the Coverage Gap portion of their plan because of their high medication cost or drug use.  The Donut Hole discount provides a discount for brand name drugs and generic medications.  You can read about the Medicare Part D Donut Hole Discount here:  Q1FAQ.com/470

Medicare Part D plan enrollment?
You can enroll in a Medicare Part D plan by calling the plan, working with an agent that represents the plan, or calling Medicare at 1-800-633-4227.  You can also enroll online at Medicare.gov, the Medicare plan's website or with a few agents that provide an online enrollment option.

Still not sure about all of this information?
If you are new to the Medicare Part D program, you may wish to start here: Help! Where Do I Start?

Medicare Supplements
fill the gaps in your
Original Medicare
1. Enter Your ZIP Code:
» Medicare Supplement FAQs

Browse FAQ Categories

Tips & Disclaimers
  • Q1Medicare®, Q1Rx®, and Q1Group® are registered Service Marks of Q1Group LLC and may not be used in any advertising, publicity, or for commercial purposes without the express authorization of Q1Group.
  • 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 PDPCompare.com and MACompare.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.
    Statement required by Medicare:
    "We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options."
  • 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.