Prescription Drug Coverage

Medicare Part D: Prescription Drug Coverage Explained Clearly

Medicare Part D helps cover the cost of prescription medications. But not all drug plans are the same — and choosing the wrong one can cost you more than you expect.

We help you compare Part D plans based on your actual prescriptions and pharmacy.

No pressure. No obligation. Just clarity.

What Does Medicare Part D Cover?

Medicare Part D provides prescription drug coverage. It is offered by private insurance companies approved by Medicare.

Part D plans:

💊 Cover generic and brand-name drugs
📊 Use tier systems to determine cost
💵 Have monthly premiums
📋 Include deductibles (depending on plan)
🔄 Change formularies annually

Each plan has its own drug list — called a formulary.

Your medications may be covered differently depending on the plan. See the Medicare glossary for key terms.

Not All Drug Plans Cover Medications the Same Way

Two plans in the same ZIP code can:

Cover the same drug at different tier levels
Charge different copays
Use different pharmacy pricing
Have different deductible structures

Even if premiums look similar, total yearly costs can vary significantly.

That’s why comparing based on your prescriptions matters.

Understanding How You Pay for Prescriptions

Most Part D plans include:

💲

Monthly Premium

The amount you pay each month to have the plan.

📅

Annual Deductible

Some plans require you to pay a deductible before coverage begins.

🧾

Copays or Coinsurance

The amount you pay when you fill a prescription.

📊

Coverage Phases

Depending on total drug costs, your cost-sharing can change during the year.

Understanding these moving parts helps prevent surprise costs.

Common Prescription Drug Plan Mistakes

⚠️ Choosing based only on premium
⚠️ Not checking tier placement for your specific medications
⚠️ Ignoring pharmacy pricing differences
⚠️ Forgetting that formularies change annually
⚠️ Missing the enrollment deadline and facing penalties

Even small errors can affect your annual medication costs. ➡ Read More About Common Medicare Mistakes

Part D and Medicare Advantage

How you get drug coverage depends on which Medicare path you’re on.

Original Medicare + Supplement

You will need a standalone Part D plan for prescription drug coverage. ➡ Learn About Supplement Plans

Medicare Advantage

Drug coverage is usually bundled into your plan — no separate Part D needed. ➡ Learn About Advantage Plans

In both cases, reviewing drug coverage annually is important.

Enrollment Periods for Part D

You can enroll or change your Part D plan during:

🎂

Initial Enrollment Period

When you first turn 65 and become eligible for Medicare. ➡ Turning 65 Guide

📅

Annual Enrollment Period

October 15 – December 7 each year. This is when most plan changes happen. ➡ Annual Review Guide

Special Enrollment Periods

Triggered by qualifying life events like moving, losing coverage, or other changes. ➡ See all enrollment periods

⚠️ Don’t Miss Your Window

If you delay enrolling without other creditable drug coverage, you may face a late enrollment penalty — an extra cost added to your premium for as long as you have Part D.

We Compare Plans Based on Your Actual Prescriptions

Instead of guessing, we:

1

Review Your Medication List

2

Compare Plans in Your ZIP Code

3

Check Tier Placement & Pricing

4

Evaluate Total Yearly Cost

Not just premiums

5

Explain Trade-Offs Clearly

If your current plan is still appropriate, we’ll tell you.

If there’s a better option, you’ll understand why.

Not Sure If Your Drug Plan Still Fits?

Take our short Medicare Clarity Quiz to see if a review might help. ➡ Take the Medicare Clarity Quiz

New to Medicare? Take the Supplement vs Advantage Quiz instead →

Takes less than a minute.

Frequently Asked Questions

Do all Medicare Part D plans cover the same drugs?

No. Each plan has its own formulary and tier system. A drug that is well-covered on one plan may cost significantly more on another.

Can I change my Part D plan every year?

Yes, during the Annual Enrollment Period (October 15 – December 7). This is the best time to review your drug coverage and make changes for the following year.

What happens if I don’t enroll in Part D when eligible?

You may face a late enrollment penalty — an additional cost added to your monthly premium for as long as you have Part D coverage — unless you have other creditable drug coverage.

Are pharmacy prices different between plans?

Yes. Pricing agreements vary by plan and pharmacy. The same medication can cost different amounts depending on which pharmacy you use and which plan you’re enrolled in.

Do I need Part D if I have Medicare Advantage?

Most Medicare Advantage plans include Part D drug coverage built in. If yours does, you don’t need a separate plan. However, if you switch to Original Medicare, you’ll need standalone Part D coverage.

Do I need Part D if I have a Medicare Supplement?

Medicare Supplement plans do not include prescription drug coverage. You’ll need a separate standalone Part D plan to cover your medications.

Can my Part B premium be reduced?

If you’re in a Medicare Advantage plan, some offer a Part B giveback that reduces your monthly Part B premium. This isn’t available with standalone Part D plans.

Ready to Compare Your Prescription Drug Options?

Book a free Medicare review and make sure your Part D coverage fits your medications and budget.

Licensed independent Medicare advisor. Reviews provided at no cost to you.