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Medicare Prescription Drug Plans

Medicare Part A and Part B does not provide prescription drug coverage at the pharmacy or for prescriptions received through the mail. It only includes coverage for prescription drugs while hospitalized. If you regularly take prescription medication, the out-of-pocket costs could be substantial if you only have Medicare Part A and Part B. Fortunately, private insurance carriers offer Medicare Part D plans to cover some costs of prescription drugs.

Enrollment in Medicare Part D is similar to Medicare Advantage. You can enroll during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday (starting with 3 months before you turn 65, continuing the month that you turn 65, and ending 3 months after you turn 65). Those who are under 65 may be eligible to enroll in a Medicare Part D plan if they have a qualifying disability. You may also enroll in a Medicare Part D plan during the Open Enrollment Period. Open Enrollment begins on October 15 and ends on December 7 in 2022. If you miss Open Enrollment, you could still get a plan if you qualify for Special Enrollment. You may qualify for Special Enrollment if you experience certain life changes, such as moving to a new state or losing health coverage.

Medicare Part D plans can be purchased as either (1) standalone coverage, which is in addition to Medicare Part A and Part B or a Medigap plan, or (2) as part of a Medicare Advantage plan.

Medicare Part D: Coverage and Costs

Though Medicare Part D plans are provided by private carriers, they are still regulated by the government. All Part D plan must cover the following:

  • At least two different drugs from all categories of medications.
  • At the least the majority of drugs from the following categories:
    • Cancer
    • Immunosuppressants
    • Anti-depressants/anti-psychotics
    • HIV/AIDS

When shopping for a plan, it is best to check if the prescription drugs that you currently take - or those that you think you might need at one point - are covered as part of the plan. Each plan has a different list of covered drugs. This is known as the plan’s “formulary.” If a drug is not on the list, then you generally have to pay the full price for that drug.

There are two types of Medicare Prescription Drug Plans:

Medicare Part D Plan Type:

Description:

Medicare Advantage Prescription Drug Plans (MAPDs)

This is the type of drug plan you will get if you plan on getting a Medicare Advantage Plan.
Most comprehensive Medicare Advantage Plans are already packaged with this drug plan, but be sure to verify before enrolling.

Prescription Drug Plans (SPDPs)

This is the type of drug plan you can get if you have a Medicare Supplement plan or just Medicare Part A and Part B.
It is a stand-alone plan and must be purchased separately from other plans.
You cannot purchase this type of plan if you have Medicare Advantage.

The premiums for Part D Medicare plans can vary from carrier to carrier and from state to state.

For those currently on Medicaid or Supplemental Security Income (SSI), you may qualify for the Medicare Extra Help Program. The Medicare Extra Help Program is a government subsidy program that reduces your Part D premiums and deductibles. It can also remove the “donut hole”, giving you coverage with no limits.

Quick Facts:

  • You can buy a Medicare Part D plan separately or as part of a Medicare Advantage plan.
  • Rates can vary across carriers and the state you live in.
  • Plans by law are standardized to cover the most common medications. However, when shopping for a plan, it is important to check the plan’s formulary, or the exact medications the plan covers.
  • Medicare Part D plans can be purchased during the Initial Enrollment Period, which is the 7 months surrounding your 65th birthday – 3 months before you turn 65, the month you turn 65, and 3 months after you turn 65 - or during the Open Enrollment Period, which begins on October 15 and ends on December 7. You may still be able to enroll in a plan if you miss these enrollment windows if you experience certain life changes, such as moving or losing health coverage.
  • Those who are under 65 may be eligible to enroll if they have a qualifying disability.

Please submit your zip code to start comparing Medicare Part D plans You can also call (833) 596-1919 TTY users 711  Mon - Fri: 6am - 5pm, Sat: 5am - 8pm PT to speak with a licensed insurance agent.

Still looking for rates? Medicare-2022.org, a licensed health insurance broker, can help you get a competitive quote.
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Medicare-2022.org is operated by Quotelab, LLC, which is an independent broker and is not a federal or state Marketplace website. This website is owned and operated by QuoteLab, LLC, a licensed insurance agency, NPN #19911386. Invitations for application for health insurance on QuoteLab, LLC, only where licensed and appointed. License numbers are available upon request and are provided where required by law. QuoteLab's license information can be found at medicare-2022.org/licenses.html.

Federal Contracting Statement: Plans are insured or covered by a Medicare Advantage organization with a Medicare contract and/or a Medicare-approved Part D sponsor. Enrollment in the plan depends on the plan’s contract renewal with Medicare.

Third Party Material (TPMO) (Medicare.gov): We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

This website may not display all data on Qualified Health Plans being offered in your state through the Marketplace website or the federal Medicare program. This is not a complete listing of plans available in your service area. To see all available data on Qualified Health Plan options in your state, visit your state Marketplace website, go to the Health Insurance Marketplace website at https://www.healthcare.gov or consult https://www.medicare.gov.

Submitting this form does NOT affect your current enrollment, nor will it enroll you in a Medicare Advantage plan, Medicare Prescription Drug plan, Medicare Supplement Plan, or any other Medicare plan. QuoteLab, LLC is independent of the Medicare program and is neither associated with nor endorsed by The Centers for Medicare & Medicaid Services (CMS) or any other governmental agency.

The plans represented on Medicare-2022.org are Medicare Advantage HMO, PPO and PFFS organizations and stand-alone prescription drug plans with a Medicare contract. Enrollment in any plan depends on contract renewal. If you are paying Medicare Part B premium, you must continue to pay it to maintain coverage.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

Based on median Medicare Advantage benefit amounts for dental available across multiple plans and metro areas. Not all benefits available in specific plans or regions.

This information is not a complete description of benefits. Contact the plan for more information.

Limitations, copayments, and restrictions may apply.

[Benefits, premiums and/or copayments/coinsurance] may change on January 1 of each year.

Advertised Pricing:

There are several factors that impact your monthly premium; including your age, geographical location, annual income, dependents, and the type of plan you choose. Monthly premiums do not include out-of-pocket costs.

The advertised price may not be typical. It was generated using the Kaiser Family Foundation's subsidy calculator that was accessed on September 16, 2020. The following parameters were used: 21 year old adult, non-tobacco user, annual income of $24,700 in 2020, no children, and no available coverage through a spouse's employer. The resulting monthly premium was $30 per month (or $360 per year after $2,751 in subsidies) for a Bronze Plan. Even when using the same parameters, the resulting premium and subsidy calculations may be subject to change.

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