The Medicare Part D prescription drug program is not handled by Medicare; it is managed by private health insurers and health care companies that are contracted by Medicare, which offer different plans in different geographic areas. Medicare Prescription Drug Plans (Plan D) may vary in costs and availability between Medicare plans, insurance companies, and locations.
Medicare prescription drug coverage is available in two ways.
- If you have Original Medicare (Part A and Part B), you can get Medicare Prescription Drug Coverage by enrolling in a stand-alone Medicare Prescription Drug plan which will work alongside your original Medicare Benefits.
- If you have Medicare Part C, you can get Medicare Prescription Drug Coverage by enrolling to a Medicare Advantage Prescription Drug Plan which gives you the option to get your Medicare health and prescription drug benefits covered under a single plan.
To get a Medicare Prescription Drug Plan (Part D), you need:
- A list of the drugs you regularly use—including the brand names if you don’t use all generics—dosage size and frequency, and current monthly cost
- Name and address of your current pharmacy
- Information on whether you currently receive Medicaid benefits (Medi-Cal in California), and
- Information on whether you are, or think you might be, eligible for a Part D low-income subsidy.
It is important to note that you may only enroll in a plan that operates in your geographic area. This information can be found through the Medicare Plan Finder at www.medicare.gov/find-a-plan or through 800-MEDICARE (800-633-4227). You can also use your State department of insurance or directly contact any plan that interests you.
- Part D plans must offer either the defined standard benefit or an alternative equal in value. The standard benefit has a $415 deductible and 25% coinsurance up to an initial coverage limit of $3,820 in total drug costs.
- For generic drugs, you will pay 37% coinsurance and plans will pay 63%.
- Part D covers biological drugs, insulin and insulin syringes and smoking cessation drugs, drugs approved by the Food and Drug Administration (FDA) for sale in the US, drugs available only by prescription and drugs that are medically necessary and for a “medically accepted indication.”
- Medicare Prescription Drug Plans are required to offer their members adequate access to retail, mail order, home infusion and long-term care pharmacies.
- Members can obtain drugs at better prices from some network pharmacies that are preferred network pharmacies.
- Members and potential members of a plan may review the plan’s utilization management restrictions on particular drugs in the plan’s formulary, website or the Medicare Plan Finder at www.medicare.gov