What Does Medicare Part D Cover?

What Is Medicare Part D?

Medicare Part D is optional prescription drug coverage offered through private insurers approved by Medicare. It helps pay for outpatient medications, either as a standalone Prescription Drug Plan (PDP) alongside Original Medicare, or bundled into many Medicare Advantage plans (an MA-PD plan).

What Part D Covers

• Outpatient prescription medications listed on the plan’s formulary (its list of covered drugs).

• Drugs are typically organized into cost tiers — generic drugs usually cost less than brand-name ones.

• Some medications may require prior authorization, step therapy, or quantity limits depending on the plan.

What Part D Doesn’t Cover

• Medications administered in a hospital or doctor’s office (often covered under Part A or B instead).

• Over-the-counter drugs, in most cases.

• Any drug not listed on your specific plan’s formulary — formularies vary by plan and can change year to year.

Enrollment Timing Matters

If you go 63 or more days without creditable prescription drug coverage after first becoming eligible for Medicare, you may owe a late-enrollment penalty added to your premium for as long as you have Part D. You can typically enroll or switch plans during the Annual Enrollment Period (October 15 – December 7).

Frequently Asked Questions

Do I have to get Medicare Part D? No, it’s optional. But going 63+ days without creditable drug coverage after becoming eligible may trigger a late-enrollment penalty.

Is Part D included in Medicare Advantage plans? Many Medicare Advantage plans bundle drug coverage in, but not all do — confirm for the specific plan you’re considering.

Can I change my Part D plan every year? Yes, during the Annual Enrollment Period, October 15 through December 7.

What is a drug formulary? A list of medications a plan covers, organized into cost tiers. Formularies are specific to each plan and can change annually.

Does Part D cover all my medications? Coverage depends on the specific plan’s formulary; some drugs may need prior authorization or have quantity limits.

Call Us Today to see how Part D fits with your other coverage. Call 1-800-432-9757 or schedule a free consultation.