Medicare Part D

Medicare Part D is a private insurance plan that covers your prescription drugs. 

Original Medicare does not come with this kind of coverage. You’ll have to purchase a standalone plan or receive it through a Medicare Advantage plan.

What does Medicare Part D cover?

Each Part D plan is required to provide a standard level of coverage set by Medicare. 

The list of drugs covered on your plan is called a formulary. 

Plans also typically place the drugs covered into different “tiers” on the formulary. 

Both brand-name prescription drugs and generic drugs are included and that’s normally how the tiers are decided. The formulary includes at least 2 drugs in the most commonly prescribed categories and classes.

A Medicare drug plan can make some changes to its drug list during the year if it follows guidelines set by Medicare. Your plan may change its drug list during the year because drug therapies change, new drugs are released, or new medical information becomes available.

However, they have to give you at least 30 days notice unless the FDA says the drug is unsafe or its maker withdraws it from the market.

Are there any drugs not covered?

There are some drugs that will not be covered under any prescription drug plan: 

  • Weight loss or weight gain drugs
  • Any drugs for hair growth
  • Fertility drugs
  • Drugs for erectile dysfunction
  • Any over-the-counter drugs

The costs associated with Part D

Your premium will depend on your area, but there are a few costs associated with a prescription drug plan you can compare when shopping plans: 

  • Premium
  • Deductible
  • Copays
  • Late enrollment fee

You will fare much better if you sign up when you are first eligible — when you are first eligible for Medicare. Your initial enrollment period spans the three months before you turn 65 and the three months after your 65th birthday.

There are drugs all plans are required to cover

Each Part D plan is required to cover all drugs in the following categories: 

  • HIV/AIDS treatment 
  • Antidepressants
  • Antipsychotic medications
  • Anticonvulsive treatments for seizure disorders
  • Immunosuppressants
  • Anticancer drugs (unless they are being covered under Part B)

Most vaccines are also covered under Part D unless they were already paid for under Part B.

Missed your initial enrollment period?

You can always purchase a plan during the annual election period that runs from October 15 through December 7.

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