If you plan to enroll in a Medicare plan, you may be curious about how you can get help paying for prescription medications. Medicare Part D coverage is Medicare’s dedicated prescription drug coverage. If you would like to receive Part D benefits, you should learn more about the different Medicare plans available on the market. 


Part D coverage is either included in or can be added to the following different Medicare packages:

  • Original Medicare
  • Medicare Advantage
  • Some Medicare Cost Plans
  • Some Medicare Private-Fee-for-Service Plans
  • Medicare Medical Savings Account Plans


What Prescription Drugs Will Part D Insurance Cover?

The Part D plan you enroll in will have its own list of drugs that they cover. This list, called a formulary, will always include at least two different drugs from the most commonly prescribed categories and classes. This helps ensure that regardless of which medical conditions you have and which plan you choose, you can access the prescription drugs that you need. If a drug you are taking is to be removed from your plan’s formulary, your plan provider must either give you written notice thirty days before the change becomes effective or provide at least a month’s supply under the same plan rules at your next refill.  


What Are The Other “Parts” Of Medicare Insurance Policies?

Medicare coverage is divided into four different “parts” that represent different groups of benefits available to members whose coverage includes those parts. Part A covers hospital insurance, which features healthcare costs like inpatient hospital care, skilled nursing facility care, hospice care, and at-home care. Part B, on the other hand, is Medical Insurance. Therefore, Part B will help recipients pay for services from healthcare providers and other medical costs like medical equipment, preventive services, and outpatient care. Part C, also known as Medicare Advantage, is a combination of Medicare’s different parts. Part C plans bundle together the benefits of Part A, Part B, and often Part D. Although, with Part C coverage, you will only have to access a limited network of health care providers (health care costs incurred with out-of-network providers should be expected to come at a higher out-of-pocket cost.) Part C also offers extra benefits that Original Medicare doesn’t typically cover, such as vision, hearing, and dental. 


How Does Part D Coverage Work With Other Drug Coverage?

If you already have drug coverage from another source when you decide to enroll in a plan that offers Part D coverage, the drug coverage you already have may be affected by Medicare’s drug coverage. Thus, it would be best if you spoke to your benefits administrator and insurer before you make any changes to your coverage. 


Joining A Medicare Drug Plan While Enrolled in Medicare Advantage

If you are already enrolled in Medicare Advantage but don’t have Plan D coverage, you probably shouldn’t enroll in a separate Medicare Prescription Drug Plan. If you do, you will likely be reverted from Medicare Advantage to Original Medicare. You can join a separate Medicare Prescription Drug Plan without your health coverage being affected if you are enrolled in a medical savings account plan, cost plan, private fee-for-service plan, or certain employer-sponsored Medicare health plans. 


If you are looking for more information about Medicare Part D or have any other Medicare-related questions, Fidelis Consultants is here to help.