Part D Basics

What Is Medicare Part D?

By now, you’ve probably heard about Medicare Part D, the prescription drug program now available to all Medicare beneficiaries. Under Part D, you will have a variety of coverage options to help you pay for your prescriptions. Each Part D drug plan is run by a private company, so they will all look a little different from each other, but they must all meet standards set by the federal government.

Part D coverage is optional - you are not required to sign up for it. If you do decide to enroll in a Medicare prescription drug plan, you will need to pay a monthly premium, plus some out-of-pocket expenses for your medication.

What Does It Cover?

Medicare Part D provides prescription drug coverage. The Centers for Medicare & Medicaid Services is the federal government agency responsible for overseeing and approving each private Part D plan to ensure that each covers at least one drug per pharmacologic class of medically necessary drugs. This means that a Part D plan must cover at least one proton pump inhibitor, for example, but the plan is not necessarily required to cover both Prilosec and Prevacid. Many plans will choose to cover both, but it is not a strict requirement under the law. Because Part D plans have a great deal of flexibility in choosing which specific drugs will be covered in their plans, it is especially important to check before you sign up, and make sure that any plan you are interested in covers the medications you take.

If you are interested in more technical detail on which drugs should be covered under Part D, Medicare has worked closely with the United States Pharmacopeia to develop Part D plan formulary guidelines. You can visit the U.S. Pharmacopeia website for more information.

How Much Does It Cost?

In creating the Medicare Part D drug program, the government developed a “standard” plan. All Part D plans must meet or exceed this standard:

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