Prescription Drug Coverage
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What you need to know about Medicare Part D
Medicare Part D offers prescription drug coverage to anyone who is enrolled in Medicare. You can opt out of receiving this benefit; however, if you choose not to sign up when you’re first eligible, you will most likely pay a late enrollment penalty.
A few things about Medicare Part D:
Medicare prescription drug coverage is available only through private health insurers that are approved by Medicare.
You can purchase a stand-alone plan, or your prescription drug coverage can be bundled with your Medicare Advantage plan (Part C), but you must have Medicare Part A and Medicare Part B to join a Medicare Advantage plan.
Prices and coverage may vary from plan to plan, so it’s worth your while to shop around.
If you don’t sign up for prescription drug coverage (or have other creditable prescription drug coverage) as soon as you’re eligible, you may be charged a late enrollment penalty.
When to Enroll
You’re eligible for Medicare Part D:
During your Initial Enrollment Period (IEP): Begins 3 months before your 65th birthday, includes your birth month, and ends 3 months after your birth month.
When you’re under 65 and disabled: Medicare starts after 24 months of Social Security or Railroad Retirement Board disability benefits. You can sign up for Part D starting three months before the 25th month, during the 25th month, or three months after.
After enrolling in Part B during the General Enrollment Period (Jan 1 – Mar 31): You can sign up for Part D between April 1 and June 30.
You may owe a late enrollment penalty if you go without a Medicare Prescription Drug Plan for any continuous period of 63 days or more after the IEP ends. You won’t pay the penalty if you have other creditable prescription drug coverage or you get “Extra Help.”
The penalty is calculated by multiplying 1% of the national base beneficiary premium by the number of full months you were eligible but didn’t enroll.
Two Ways to Get Coverage
A stand-alone Medicare Prescription Drug Plan
A Medicare Advantage (Part C) plan with prescription drug coverage included
If you have Medicare Parts A and B and don’t want to switch to a Medicare Advantage plan, enroll in a stand-alone plan to avoid a late enrollment penalty (unless you have creditable coverage or get Extra Help). While many Medicare Advantage plans include drug coverage, some do not.
Things to Consider when Choosing a Prescription Drug Plan
Formulary: Each plan has a list of covered drugs. If your medications aren’t covered, consider another plan or ask your doctor about alternatives.
Network: Plans use pharmacy networks for better prices. Using an out-of-network pharmacy can cost more.
Mail Order: Some plans offer lower prices via mail-order and may require a 90-day supply. Check with your doctor first.
A Word about the Donut Hole
The “donut hole” (coverage gap) is a temporary limit on what your plan covers for prescriptions. In 2020, you entered the gap once you and your plan spent $4,020 on covered drugs; while in the gap, you paid 25% of the cost for covered brand-name and generic drugs.
In 2020, you remained in the donut hole until your out-of-pocket costs reached $6,350. After that, you entered catastrophic coverage and paid only a small co-pay or co-insurance for the rest of the year.
What Our Customer Says
I’m a young lawyer and had no idea how Medicare worked. I was getting so many calls and was overwhelmed until a friend told me about Medicare Service. My experience was friendly, patient, and caring. They helped me pick a Medicare Advantage plan that didn’t cost me a dime. I never felt pressured—just supported!
Running a restaurant means every minute counts, so I needed a Medicare team that could keep things simple. Medicare Service walked me through everything, answered all my questions, and helped me find a plan that actually fits my lifestyle. I finally feel confident about my coverage. What really stood out was how patient and genuine.
The enrollment process was so easy. I wasn’t sure what plan was right for me, but I got honest advice, and everything changed. My agent took time to listen to my story, explained things in a way I understood, and helped me find a plan that covered my doctors and prescriptions. Best of all, it didn’t cost me a dime. I now recommend them for Medicare coverage.
I’m a young lawyer and had no idea how Medicare worked. I was getting so many calls and was overwhelmed until a friend told me about Medicare Service. My experience was friendly, patient, and caring. They helped me pick a Medicare Advantage plan that didn’t cost me a dime. I never felt pressured—just supported!
Switching from my employer insurance to Medicare felt like jumping into the unknown. Thankfully, Medicare Service made it painless. They took the time to understand my situation and explained all my options clearly. They even checked that my heart specialist and medications were covered. I’ve already recommended them to my sister. Excellent service!
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Frequently Asked Questions
Do I have to pay for your services?
No, our help is 100% free. We’re paid by the insurance companies if you enroll in a plan, not by you. There’s no extra cost for working with us.
When can I enroll in Medicare?
Most people enroll around age 65 during their Initial Enrollment Period. There are also specific enrollment windows each year, such as the Annual Enrollment Period (October 15 – December 7), when you can make changes to your coverage.
What’s the difference between Medicare Part A, B, C, and D?
Medicare Part A: Hospital coverage (inpatient stays, skilled nursing, hospice, some home health).
Medicare Part B: Medical coverage (doctor visits, outpatient care, preventive services).
Medicare Part C: Medicare Advantage plans offered by private companies, combining Parts A & B and often including extra benefits like dental, vision, or prescriptions.
Medicare Part D: Prescription drug coverage.
Can I change my Medicare plan later?
Yes. You can make changes during the Annual Enrollment Period each year, and sometimes during Special Enrollment Periods if you qualify (for example, moving to a new area or losing other coverage).
Will I lose my doctor if I switch plans?
It depends on the plan you choose. Some Medicare Advantage and Part D plans have provider networks. Before switching, we’ll help you check whether your doctor is included in the plan’s network so you can keep your preferred providers.