What is Medicare Part D?

Medicare Part D is insurance for your prescription needs. When enrolled in Medicare Part D, you pay a monthly premium to an insurance carrier for your Part D plan. You then use the insurance carrier’s network of pharmacies to purchase your prescription medications.

Medicare Part D allows you to pay a copay or percentage of your drug’s cost instead of paying full price for your prescriptions. Each plan varies in cost and the drugs covered, but all Medicare Part D plans follow federal guidelines, and every insurance career will submit its plan outline to the Centers for Medicare and Medicaid Services yearly to be approved.

Every Medicare Part D plan has a list of drugs covered, called a formulary. If the drug you need is not on the formulary, you may request an exception, pay out-of-pocket, or submit an appeal. Because each formulary varies from plan to plan, ensure you request a copy to make sure you are on a plan that covers the drugs you will need.

Each plan has to cover all drugs in the following categories:

• Antidepressants
• HIV/AIDS treatment
• Immunosuppressants
• Antipsychotic medications
• Anticonvulsive treatments for seizure disorders
• Anticancer drugs (unless they are being covered under Part B)

Many companies offer Part D plan options, and you will likely have a variety of different choices. Big brands in the health insurance industry offer Medicare Part D Plans, such as Blue Cross and Blue Shield, Aetna, Humana, and smaller companies. Some plans will use a pharmacy network, so if there is a pharmacy you regularly use near you, make sure that it is a part of your plan’s network.