How to buy your Part D plan

Medicare Part D plans cover outpatient prescription drugs. Choose from a standalone plan or drug coverage included in a Medicare health plan. Which one’s right for you?

When I shop online, sometimes the company will suggest an item that pairs well with what I am buying. If I’m buying a slow cooker, they might suggest a cookbook to go with it. I like that! I have the option to buy the slow cooker alone, or buy the items together.

You can apply that same approach to buying a Medicare Part D plan. Buy it alone, or buy it with your health coverage.

First, it’s important to know that Original Medicare includes Part A (hospital coverage) and Part B (doctor visits, outpatient care and supplies). But it doesn’t include coverage for most outpatient prescription drugs, like the medicines you take every day or for short periods of time. A Part D prescription drug plan would help pay for these types of medicines.

Two ways to get a Part D plan

You can buy a Part D prescription plan from a private insurance company that has a contract with Medicare.

Here’s what you need to get Part D:

  • Enroll in Medicare Part A or Part B, or both
  • Live in a county where the plan is offered

And here are the ways you can get coverage.

1. MEDICAL + PART D IN ONE MEDICARE PLAN

You can get both medical and prescription drug coverage in some Medicare Advantage or Medicare Cost plans. Check if these types of Medicare plans are available in the county where you live. Both plan types give you the convenience of working with one insurance company, one member services team and one ID card. See the Three benefits of including Part D in your Medicare plan.

2. STANDALONE PART D PLAN

A standalone plan provides coverage just for your prescription drugs. You would enroll in this type of plan if:

  • You use Original Medicare for your health care needs and want prescription drug coverage.
  • You have a Medicare Supplement plan. These plans don’t include outpatient prescription drug coverage, so you’ll choose a standalone Part D plan too.
  • You have a Medicare Cost plan without outpatient prescription drug coverage.

Things to consider when shopping for a plan

It’s a good idea to make a list of the medicines you take, including the drug name and dosage. Then check the plan’s drug list (it’s called a formulary) to make sure the plan covers your medicines.

Part D plans and Medicare plans with Part D coverage will have a network of pharmacies. You pay the least amount for your prescriptions when you use a pharmacy in the network. Check the list to make sure your pharmacy, or a pharmacy you are willing to use, is part of the network.

Avoid a penalty and learn more about drug coverage

The Centers for Medicare & Medicaid Services (CMS) wants everyone with Medicare to have a Part D plan. If you don’t, you’ll likely have to pay a penalty if you enroll in one later. That penalty gets added to the monthly premium and continues as long as you have a Part D plan. So even if you don’t take medicines now, you may want to enroll in a plan to avoid that penalty.

Enrolling in the right plan is important and so is learning about how Part D works. Get a quick summary in the video, The four stages of Medicare Part D. You can also get up to speed by reading our featured posts about drug coverage.

NEED MORE HELP? CHECK OUT THESE RESOURCES:

The State Health Insurance Assistance Program offers free, independent counseling services and local workshops to help with your health care benefit decisions.

Visit medicare.gov, or talk to a Medicare expert, like an agent, broker or health plan sales rep.

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