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.)
A Medicare Part D prescription drug plan works just like any other type of insurance:
You first review 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 then 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 if you need help finding a plan and enrolling into a plan. You can use our Formulary Browser to see the drugs covered by any plan (and at what cost): see https://Formulary-Browser.com
Medicare Part D drug plans cover thousands of drugs, but drug plans are not required to cover all known prescription
drugs. 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. 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.
Once you are enrolled in the Part D plan, 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).
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)
An 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
Medicare Advantage plans are also called Medicare Part C.
- 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).
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.