Medicare Part D

Last updated: October 7, 2015

Prescription Drug Coverage

What Is Part D?

Medicare provides prescription drug coverage to help enrollees pay for the drugs they need to stay healthy. Everyone with Original Medicare or a Medicare Advantage Plan can choose to enroll in this voluntary drug coverage regardless of their income, health, or how they currently pay for their prescriptions.

Like Medicare Advantage Plans, Part D prescription drug coverage is run by private companies approved by Medicare.

  • Part D can be added to either Original Medicare or a Medicare Advantage Plan. (Check to make sure your Advantage Plan doesn’t already include Part D.)

  • You must have Part A or Part B to receive Part D coverage - it cannot stand alone.

Enrollment in Part D

You have the option to enroll in Part D during your initial enrollment period.

  • You must pay a monthly premium for this coverage.

  • The cost for each Part D plan varies based on the company selling the policy, and those individuals with a higher modified adjusted gross income may pay a higher premium each month.

Like Part B, if you choose not to enroll in Part D during your initial enrollment period, then change your mind, you may be charged a late enrollment fee. So, it is important to evaluate your coverage needs during your initial enrollment period. You will be charged more for Part D coverage if you enroll after your initial enrollment period.

How Does Part D Work?

Medicare prescription drug plans vary. In general, when you join, you will pay a monthly premium in addition to any premiums for Medicare Part A and Part B.

  • You may also pay a deductible for your prescriptions.

  • After you pay the yearly deductible, you will pay varying coinsurance amounts.

Medicare prescription drug plans can offer more generous coverage for higher premiums. Joining is your choice. However, if you don’t join when you first become eligible, you may have to pay a higher premium should you decide to join later. You will have to pay this higher premium for as long as you have a Medicare prescription drug plan.

Things To Remember:

  • If you want coverage, you must enroll. Enrollment is not automatic.

  • Once you’re enrolled, you will pay a monthly premium.

  • If you have a low income and limited assets, you may qualify for the "Extra Help" program to help with the costs.

Part D “Extra Help”

Some people qualify for government assistance in paying for Part D through a program called "Extra Help." This program can assist with the costs of monthly premiums, annual deductibles, and prescription copayments.

In Order To Qualify for This Program, You Must Meet the Following Criteria:

  • Reside in one of the 50 states or the District of Columbia.

  • Have limited resources of $13,640 (single) or $27,250 (married couple living together).

    • In this case, resources include bank accounts, stocks and bonds, but do not include things like your home or car.

  • Have an annual income of less than $17,655 (single) or $23,895 (married couple living together).

Even if you make more each year, you may qualify for some assistance. Check with your local Social Security office for more information.

To find out more about the "Extra Help" program, contact your local Social Security office or call 800-772-1213. You can also get more information, and even enroll in the program, by visiting Social Security online at www.ssa.gov/prescriptionhelp/.

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