What does Medicare Part D Cover?
Medicare Part D is the prescription drug benefit offered through insurance companies as a stand-alone plan. Additionally, beneficiaries can choose a Medicare Advantage plan that also features prescription drug coverage.
Each Part D plan has a list of drugs that are covered. This is called a formulary. If the drug you need is not on the formulary, you can request an exception, pay out of pocket, or file an appeal.
Formularies differ from plan to plan so make sure to request a copy when enrolling in Medicare Part D. There are certain drugs that are covered in every plan. That includes:
- HIV/AIDS treatment
- Antipsychotic medications
- Anticonvulsive treatments for seizure disorders
- Anticancer drugs (unless they are being covered under Part B)
In general, most vaccines are also covered under Part D unless already covered in your Medicare Part B plan.
As mentioned, Medicare part D doesn’t cover every prescription, so what drugs doesn’t Part D cover?
Prescription drug plans (Part D) will not cover any medications that Original Medicare covers for you. In addition to that, there are a few medications that Part D will not typically cover including:
- Any weight loss or weight gain drugs
- Fertility medication
- Over-the-counter medication
- Erectile dysfunction medication
- Cosmetic drugs
While it is possible to find a Part D carrier that offers these medications, it is not the norm. If you feel like you need a drug not on a formulary you want to be on, you have the right to ask for an exception.
How do I enroll in Plan D (prescription drug coverage)?
Medicare Part D Plans are essentially pharmacy cards that give you lower cost medications. You will enroll through an insurance company in your home state that is licensed in Medicare services. You can also enroll in Medicare Part D through Medicare’s website. Instead of paying the full cost for your prescriptions, you will pay only the copays required by the plan.
Part D is voluntary, so it is not required to enroll, though million of Americans opt to do so. If you would like to enroll in Medicare Part D, make sure your plan will cover all the drugs you require.
If you fail to enroll in Part D during your Medicare Initial Enrollment Period, you will have to wait for a future Annual Election Period to enroll, meaning you may be without coverage for a few months before you can get into a plan. You will also be assessed a late penalty later on when you do enroll. The only exception to this is if you didn’t enroll because you had other creditable drug coverage, like employer coverage or VA benefits. The penalty grows with time, so don’t delay.
Who is eligible for Medicare Part D?
You are eligible for Part D so long as you are enrolled in either Part A or B and live in the service area. This plan is voluntary, but strongly recommended if you have no other drug coverage. Part D provides insurance against catastrophic education costs and offers lower copays on medications you take now.