What it is
Medicare Part D plans are prescription drug coverage offered by private insurance companies that are approved to participate in Medicare. They are designed to help with the cost of medications you take regularly or may need in the future.
Each plan has a formulary, which is its list of covered drugs. Plans may group drugs into tiers, and the way you share costs can differ by tier, by pharmacy and by plan. Details such as premiums, deductibles and copays vary by carrier, state and year, so they are not listed here.
Part D can be purchased as a stand-alone plan, often paired with Original Medicare and a Medigap policy, or it may come bundled inside many Medicare Advantage plans. Medigap policies sold today do not include drug coverage, so a separate Part D plan is generally needed with them.
How it’s traditionally been approached
People have traditionally looked at Part D by starting with their medication list. They check whether each drug is on a plan's formulary, which pharmacies are preferred, and whether any rules such as prior authorization or step therapy apply.
Many people review their coverage during the annual enrollment period each fall, since plans can change their formularies, costs and networks from one year to the next. Others use special enrollment periods when life circumstances change, such as moving or losing other coverage.
Some people choose a stand-alone Part D plan alongside Original Medicare, valuing the freedom to see any provider that accepts Medicare and predictable cost-sharing through Medigap, while accepting that Medigap generally has higher premiums and may involve medical underwriting outside open enrollment or guaranteed-issue periods. Others prefer a Medicare Advantage plan that often includes drug coverage and extra benefits, while accepting provider networks, prior authorization and varying cost-sharing. Neither path is right for everyone.
How the right agent may help
A licensed independent agent may help by walking through your medications, preferred pharmacies and doctors, and explaining how different plans may treat them. A conversation is generally informational, and you stay in control of every decision.
Helpful questions to ask include: Are my current drugs on the formulary? Which pharmacies are in network or preferred? Are there restrictions such as prior authorization? How might costs change during the year? What happens if my medications change?
Agents must be licensed in each state where they sell, and Medicare plans are sold by agents appointed with each carrier. Confirm an agent's license with your state insurance department. For current rules, you can also visit Medicare.gov or speak with a licensed agent. An agent can only offer the plans they are appointed with, so you may wish to ask which carriers they represent.
The bigger picture
Prescription coverage touches both health and peace of mind. Knowing how your medications are covered may reduce worry about unexpected costs, and that calm can make it easier to focus on taking care of yourself.
Looking at the whole picture, including your doctors, pharmacies, budget and comfort with planning, can help you choose coverage that fits your life. If you are also looking for care providers, Providers.plus is one place to explore.
Keep in mind
- This page is educational only and is not insurance, legal, tax, medical or financial advice. 2A Benefit is not an insurer and does not sell policies; licensed agents provide quotes.
- 2A Benefit is an independent, privately run site, not connected with or endorsed by the U.S. government, Medicare, CMS, Medicare.gov, HealthCare.gov or any government agency.
- Premiums, deductibles, copays and formularies vary by carrier, state and year, and no plan can be promised as the best or as guaranteed to be available to you.
- Enrollment periods and penalties can apply, so check current rules with Medicare.gov or a licensed agent.
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Frequently asked questions
What are Medicare Part D plans?
Medicare Part D plans are private prescription drug plans for people with Medicare. They cover a list of medications called a formulary, and the details vary by plan, carrier and year. They may be stand-alone or included in some Medicare Advantage plans.
Do I need a Part D plan with Medigap?
Generally yes, if you want prescription drug coverage. Medigap policies sold today do not include drug coverage, so people often add a separate stand-alone Part D plan. A licensed agent can explain how the pieces fit together.
Do Medicare Advantage plans include Part D coverage?
Many Medicare Advantage plans include drug coverage, though not all do. Included drug coverage is often seen as a convenience, but networks, prior authorization and cost-sharing can vary. Review each plan's details before choosing.
How do I compare Medicare Part D plans?
Start with your medication list and check each plan's formulary, pharmacy options and any restrictions. Then look at how costs are structured, since these vary by plan and year. A licensed agent or Medicare.gov can help you compare current options.
When can I enroll in or change a Part D plan?
Most people can review and change plans during the annual enrollment period in the fall, and special enrollment periods may apply after certain life events. Rules can change, so confirm current timing with Medicare.gov or a licensed agent.
How can I check that a Medicare agent is licensed?
Contact your state insurance department to confirm an agent's license in your state. Agents must be licensed where they sell and appointed with each carrier whose Medicare plans they offer. 2A Benefit is an independent directory and does not sell policies.
Educational resource. 2A Benefit shares general information and connects people with independent agents. It is not professional advice. Talk with a qualified professional about your own situation.