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Original Medicare does NOT cover prescriptions. Therefore, individuals with Part A and/or Part B, may need to purchase a Prescription Drug Plan (Part D) to have prescription coverage. 

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Part D plans are provided by private health insurers. Each plan is different and has their own Premium, Deductibles, Copayments, Coinsurance, and Drug Formulary (prescriptions covered). However, all plans must follow Medicare's rules relating to Stages -- how you pay for prescriptions over a calendar year. Click our 2023 Stages Resource Link above to learn more, including the infamous Donut Hole. 

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Most Part D plan holders have secondary medical coverage, like a Medicare Supplement plan or Medicaid.

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Individuals with Medicare Advantage (Part C) typically have Part D incorporated into their plans and do not require a standalone-Part D plan. Some individuals may not be required to have a Part D plan if they have creditable coverage elsewhere like VA Coverage or TriCare for Life. 

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Individuals may qualify for Extra Help or their State's Pharmaceutical Assistance Program (SPAP) which may help cover their prescription-portion of their premium, Part D Late-Enrollment Penalty, Coverage Gap, and provide a ceiling price to covered prescriptions. 

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Part D is often one of the most complicated parts of Medicare, so check out our Commonly Asked Questions above to learn more about common questions and misconceptions regarding Part D drug Coverage. If you have a question not answered, or would like to discuss Part D in more detail including Extra Help/SPAP, feel free to reach out to HEALTHFOCUS PARTNERS.

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