Learn About Medicare Part D

Medicare Part D is a federal program designed to help people afford their prescription medications. This program is administered through insurance companies who partner with Medicare to offer drug coverage plans to individuals who are eligible for Medicare. Medicare Part D plans are only available to those who are already enrolled in Medicare, which includes individuals over the age of 65, those with certain disabilities, and people with End-Stage Renal Disease (ESRD).

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How does Medicare Advantage Part D Differ from Original Medicare?

Medicare Advantage (Part D) is different from Original Medicare because it is a plan offered by private insurance companies, whereas Original Medicare is a government-run program. Medicare Advantage (Part D) combines healthcare coverage and prescription drug coverage, whereas Original Medicare only covers certain prescription medications. With Medicare Advantage (Part D), beneficiaries can choose from a variety of plans offered by different insurance companies, depending on their budget and healthcare needs. Medicare Advantage (Part D) plans may have different monthly premiums and out-of-pocket costs and can offer additional benefits beyond what is covered under Original Medicare.

What are the Benefits and Coverage Options Offered by Medicare Part D Plans?

Medicare Part D plans offer a variety of benefits and coverage options to meet the needs of different individuals. These benefits can include coverage for both generic and brand-name prescription drugs, as well as specialty medications. Beneficiaries also have the option to choose between different levels of coverage, with some plans requiring higher out-of-pocket costs and others offering more comprehensive coverage. Many Medicare Part D plans also offer mail-order options for prescription medications, which can save beneficiaries time and effort in obtaining their medications.

Are Prescription Drugs Covered Under Medicare Part D Plans?

Prescription drugs are indeed covered under Medicare Part D plans, although the specific medications covered will depend on the beneficiary’s plan. All Medicare Part D plans must cover medications that are considered “medically necessary,” and these drugs must be approved by the Food and Drug Administration (FDA). Medications that are not approved by the FDA or are considered “experimental” may not be covered under Medicare Part D plans. Additionally, Medicare Part D plans may place restrictions on certain drugs, such as requiring prior authorization or limiting the amount of medication that can be obtained at one time. Beneficiaries should consult with their plan provider and healthcare provider to determine which medications are covered under their specific plan.

We do not offer every plan available in your area.  Currently we represent 10 organizations which offer 37 products in California.  Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.