Part D Prescription Drug Plans

Part D covers prescription drugs. Original Medicare does not, so unless your drug coverage comes bundled into a Medicare Advantage plan, you buy it as a standalone policy.

The cheapest plan is often not the cheapest plan

Every Part D plan publishes a formulary: the specific list of drugs it covers and which pricing tier each one sits in. Those lists differ substantially between plans.

So the plan with the lowest monthly premium can easily be the most expensive one for you, if one of your medications sits on a high tier or is not on its list at all. What matters is the total for the year — premium plus what you actually pay at the pharmacy for your actual prescriptions.

That comparison takes about ten minutes with the right tool, and it is one of the more genuinely useful things an agent does.

The late enrolment penalty

If you go 63 days or more without creditable drug coverage after becoming eligible, a penalty is added to your Part D premium. It is calculated from how many months you went without, and in most cases you pay it for as long as you have Medicare.

This catches out people who take no medication and reasonably conclude they do not need drug coverage. Enrolling in an inexpensive plan is almost always cheaper over time than accepting the penalty.

Coverage through an employer, the VA, or TRICARE is often creditable, which means no penalty accrues. Check rather than assume — your plan administrator can confirm it in writing.

Review it every year

Formularies and tier placements change annually, and so do the drugs you are prescribed. A plan that was the right answer last year may quietly stop being it. Reviewing during Annual Enrollment, between October 15 and December 7, is free and takes very little time.

Help with costs

Extra Help, also called the Low Income Subsidy, can substantially reduce Part D costs for people who qualify on income and assets. Many people who are eligible have never applied. Ask us and we will tell you whether it is worth looking into.