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What is a Medicare Part D PDP?


A Medicare Part D PDP is a stand-alone Medicare Part D prescription drug plan that provides insurance coverage for your out-patient prescription drugs.  (Prescription drugs you receive in the hospital or a doctor's office may be covered by your Medicare Part A or Medicare Part B.)

So like any insurance, you will pay a monthly premium (unless you join a plan with a $0 premium), pay an initial deductible (unless you join a plan with a $0 deductible or have a plan that excludes low-costing generics from the deductible), and receive some form of coverage for any drugs that are on your plans drug list or formulary at participating pharmacies (or pharmacies within the plans network).

Note: Low-income Medicare beneficiaries may qualify for the Medicare Part D Extra Help program and have lower (or no) monthly premiums and pay very low costs for formulary drugs throughout the year.

Every Medicare Part D or Medicare Advantage plan is a little different with different premiums, initial deductibles, drug coverage (plans do not cover the same drugs), and cost-sharing (what you pay for your drugs).  For more information, please see our popular Frequently Asked Question, "What is a Medicare Part D plan?" found at: https://Q1FAQ.com/563.html

How to choose a Medicare Part D PDP?

In general, you want a Medicare Part D plan that provides the most economical drug coverage at the pharmacies you usually visit.  To learn more:

(1)  What PDPs are available to you?
You can begin by reviewing the Medicare plans that are available in your area (see our Medicare Part D Plan Finder at https://PDP-Finder.com - you can click here for an overview of our PDP Finder or just choose your state to get started).  You will see that each stand-alone Medicare Part D PDP provides unique coverage with different monthly premiums, deductibles, coverage cost, and drug coverage.

PDP-Finder showing an example of all stand-alone Medicare Part D plans in a selected state or Service Area
(2) What drugs are covered by the Medicare Part D PDP?
Be sure to review the PDPs Formulary (drug list) and cost-sharing and usage management restrictions to learn more about how your PDP will cover your prescriptions.

Important: Medicare Part D drug plans cover thousands of drugs(2,000 to 4,000), but drug plans are not required to cover all known prescription drugs - and all drugs are not covered at the same cost - and some drugs have additional coverage restrictions.  Instead drug are only required to cover a fixed number of drugs in certain drug classes to be sure that all drug plans have a well-rounded offering of prescriptions.

You can also use our Formulary Browser to see the drugs covered by any plan (and at what cost and with what restrictions): see https://Formulary-Browser.com.

The medications covered by a Medicare Part D plan are organized in a formulary or drug list and you need to check the formulary to ensure your drugs are covered - or you can ask your Medicare plan to make an exception and cover a non-formulary drug - but a drug plan is not required to grant your request.  Some drugs are also excluded by law from Medicare Part D coverage, but may be covered by your plan as supplemental drugs.

(3)  Ready to enroll or need additional assistance?
If you are ready to choose a Medicare Part D plan that most economically covers your medications at your chosen pharmacy - call a Medicare representative at 1-800-633-4227 for enrollment assistance or a Medicare representative can offer help finding a plan and enrolling into a plan.

(4)  What happens after enrollment?
Once you are enrolled in the Part D PDP, you will pay a monthly premium (like any other insurance), then you may pay an initial deductible before your plan coverage begins (although some drug plans have a $0 deductible).  You and your Part D plan will then each share a portion of the drug's coverage costs (for example, your Part D plan may pay 75% of retail drug prices and you pay the 25% balance - or you may pay a $2 co-pay for your generic drugs and a $47 co-pay for brand-name drugs).

Are there any alternative ways to get Medicare Part D coverage?

Yes:  Your Medicare Part D prescription drug coverage can be provided in several ways:
  • A "stand-alone" Medicare Part D prescription drug plan (PDP)

    A PDP only provides prescription coverage - and perhaps some supplemental or over-the-counter drug coverage (in limited cases).
     
  • A Medicare Advantage plan that includes prescription coverage (MAPD)

    A MAPD includes your Medicare Part D prescription drug coverage (like a PDP) - plus an MAPD includes Medicare Part A coverage (for in-patient and hospital care)plus Medicare Part B coverage (for out-patient and physician care) - and often other benefits such as basic dental coverage, optical coverage, hearing aid coverage, and fitness coverage (maybe even transportation coverage, home healthcare, and other supplemental benefits) - all for one monthly premium.

    Medicare Advantage plans are also called Medicare Part C.

  • Your employer or union drug coverage.  Your current or past employer (or spouse's employer) may provide coverage of your prescription drugs that is as good as Medicare Part D coverage (or "creditable" drug coverage).  If you have creditable employer or union drug coverage you do not need to join a Medicare Part D drug plan (PDP or MAPD).

    Important:  If you are receiving prescription drug coverage from your employer, the key is to ensure that any Employer Health Plan provides "creditable" prescription drug coverage so that you avoid any Late-Enrollment penalties.

  • Finally, you can also receive "creditable" prescription drug coverage from other sources such as your Union, Employer Health Plan, TRICARE for Life, or the Veterans Affairs (VA).







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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.