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Part D
Understanding
Prescription Coverage
Medicare Part D helps cover the cost of your prescription medications. These plans are offered by private insurance companies approved by Medicare, and each plan has its own list of covered drugs and costs.
When It Applies
Coverage begins when you enroll in a Medicare drug plan and meet the plan’s applicable requirements.
What's Covered
Covered prescription drugs are listed on the plan’s formulary. Coverage rules such as prior authorization, step therapy, or quantity limits may apply.
How Long You're
Covered
Prescription drug coverage continues while you remain enrolled and meet the plan’s requirements. Formularies, coverage rules, and costs may change.
What You'll Pay
Prescription drug costs vary by plan, medication, pharmacy, and coverage stage. Premiums, deductibles, copayments, or coinsurance may apply. Review your plan’s current Evidence of Coverage and formulary for specific costs.
Initial Coverage
Formularies, cost-sharing, pharmacy networks, and coverage requirements vary by plan. You must continue paying any applicable Part D premium.
When It Applies
Catastrophic coverage begins after you reach the applicable out-of-pocket threshold for covered Part D drugs.
What's Covered
Covered Part D prescription drugs listed on your plan’s formulary. Coverage requirements may apply.
How Long You're
Covered
Catastrophic coverage continues through the end of the calendar year once the applicable threshold is reached.
What You'll Pay
Cost-sharing during catastrophic coverage is determined by current Medicare rules and your plan. Review your plan’s Evidence of Coverage for specific costs.
Catastrophic Coverage
Formulary, coverage, and cost-sharing requirements vary by plan. You must continue paying any applicable Part D or plan premium.
When It Applies
When you use your Part D coverage for a prescription included on your plan’s formulary.
What's Covered
Covered prescription drugs and certain Medicare-covered vaccines. Formulary and coverage requirements, including prior authorization, quantity limits, or step therapy, may apply.
How Long You're
Covered
Coverage continues while you remain enrolled and meet your plan’s requirements. Formularies, pharmacy networks, and coverage rules can change.
What You'll Pay
Prescription drug cost-sharing varies by plan, medication, pharmacy, and coverage requirements. Review your plan’s current Evidence of Coverage and formulary for specific costs.
Special Rules & Plan Features
Formulary, pharmacy network, cost-sharing, and coverage requirements vary by plan. You must continue paying any applicable Part D premium.
When It Applies
If you qualify for Extra Help based on income and resource requirements.
What's Covered
Extra Help can reduce Part D premiums, deductibles, and prescription drug costs for people who qualify. Formulary and coverage rules still apply.
How Long You're
Covered
Extra Help continues while you remain eligible. Eligibility may be reviewed periodically.
What You'll Pay
Prescription drug costs are reduced for people who qualify for Extra Help. The amount you pay depends on your eligibility level, medication, and coverage. Review Medicare.gov or your plan information for current costs.
Extra Help (Low-Income Subsidy)
Formulary, pharmacy network, and coverage requirements may vary by plan.
Quick Basics about Part D
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What it covers: Prescription drugs covered by your plan’s formulary.
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How it works: Plans may use formularies, pharmacy networks, drug tiers, prior authorization, step therapy, or quantity limits.
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Costs: Costs may include a monthly premium, deductible, copayments, or coinsurance. Costs vary by plan.
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Late enrollment penalty: A penalty may apply if you go 63 or more consecutive days without Part D or other creditable prescription drug coverage after becoming eligible for Medicare.
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Medicare Advantage: Some Medicare Advantage plans include prescription drug coverage, while others do not.
DISCLAIMER: This page provides general educational information about Medicare Part D prescription drug coverage. Coverage, costs, formularies, pharmacy networks, and plan requirements vary by plan and service area and may change each year. Review your plan’s Evidence of Coverage and formulary for specific details.
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