A Guide to Understanding Medicare Part D
What is Medicare Part D?
Medicare Part D, also known as the Medicare Prescription Drug Plan, is an optional benefit that provides assistance with the cost of prescription medications. Medicare Part D is offered by Medicare approved private insurance companies in coordination with Centers for Medicare and Medicaid Services (CMS). Medicare Part D may help lower your current prescription drug costs, and it may protect you against higher costs in the future. Open enrollment occurs annually from October 15 through December 7. Individuals can enroll for the first time, select alternative coverage or renew existing coverage. Just remember, if you miss the enrollment window you may have to pay a late fee penalty.
Am I eligible?
All Medicare recipients are eligible for Medicare Part D. If you’re entitled to Medicare Part A, or you’re enrolled in Medicare Part B, you cannot be turned down for a Medicare Part D plan during your initial enrollment period. During the enrollment period, you can choose either a Medic are Advantage plan that includes prescription coverage, or a Medicare Part D plan.
It’s very important to carefully choose your Prescription Drug Plan. Each Prescription Drug Plan has a specific “formulary list,” or list of covered drugs. Prescription Drug Plans can vary wildly in price and coverage because they’re administered by private insurance companies. There are guidelines set by the federal government to ensure certain drugs are covered under all Medicare Part D Plans. Make sure the prescriptions you’re currently using are on the formulary list for the plan you select, and that your Pharmacy is included in the plan’s network.
Finally, please be aware that your plan may change its formulary. Every fall, it’s a good idea to review the Annual Notice of Change sent to you by your plan, and make sure that in the coming year it will still cover your prescription medications.
How and When Can I Enroll?
The open enrollment period for Medicare lasts from Oct. 15 to Dec. 7
This is not the period for Americans to enroll in Medicare for the first time (unless, of course, the time frame just happens to overlap with your initial enrollment period when you turn 65). The open enrollment period is a window for people who already have Medicare to review their coverage and decide whether to make any changes, for example switching their Part D prescription drug plan or moving from one Medicare option to another.
If you are 64 and turning 65 and are eligible for Medicare Part D coverage, you may enroll during the 7-month period that starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
Kiosk Centers at Your Nearest Store
We have partnered with licensed Medicare Part D agents to host informational kiosks answering all your questions and helping with enrollment in select store locations. Come and talk to a Medicare Part D agent during the open enrollment period; October 15 December 7, 2020, for a 2021 plan year coverage.
Are you ready to Enroll?
Take a look at our dedicated information page where you can find a list of plans we accept in our Pharmacies and a Medicare Part D plan Finder to help you find the best plan based on your needs.
*Restrictions and exclusions may apply. See Pharmacy for details. Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.
Your actual costs for Medicare Part D prescription drug coverage will vary depending on:
Which prescriptions you take, and how often
Whether you choose a standalone Medicare Part D Prescription Drug Plan or Medicare Advantage Prescription Drug Plan
Whether you visit a Pharmacy in your plan’s network
Whether your prescription drugs are on your Medicare Part D plan’s formulary (list of covered drugs)*
In general, most individuals will pay a premium each month for coverage. This will vary depending on the level of coverage offered by the plan you have selected. There will be an initial deductible where you will pay the full cost of your medications until you’ve satisfied your deductible. Once your deductible is met, the terms of your plan will specify the share of the costs that you will pay for your medications.
There is a secondary coverage gap, often called the “donut hole,” that may temporarily occur once your Prescription Drug Plan has paid a certain maximum amount towards your medications. More details about the specific coverage of each Prescription Drug Plan can be provided by the insurance company that administers the plan.