What Does Medicare Part D Cover?

Medicare Part D is coverage that helps pay for brand-name and generic prescription medications. It is optional coverage and offered to everyone with Medicare by insurance companies and other private companies approved by Medicare. While you may not be on any prescription medications right now, you should consider Part D in your coverage plans to avoid a late enrollment penalty if you decide to join a plan later.

If you have Medicare Part A, Part B or both, you can enroll in a Part D prescription drug plan in one of two ways:

1. As a standalone Medicare Part D prescription drug plan
2. When Part D is included in a Medicare Advantage plan like KelseyCare Advantage

Part D as a Standalone Plan with Original Medicare

This plan adds coverage to Original Medicare, some Medicare Cost plans, some Private Fee for Service plans and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance) and/or Medicare Part B (Medical Insurance) to join a separate Medicare drug plan.

Part D Bundled with a Medicare Advantage Plan

With a Medicare Advantage plan that includes drug coverage, you receive all your Part A and Part B benefits, plus many others like vision, hearing and dental. Remember, you must have Part A and Part B to join a Medicare Advantage plan, and not all plans offer drug coverage.

What Medications Are Covered by Medicare Part D?

Medications covered by your Part D plan vary based on the plan’s formulary, which is a list of medications covered by the plan and approved by the Centers for Medicare & Medicaid Services (CMS). If you currently take one or more prescription drugs, be sure those drugs are included in the formulary for the plan you are considering. All Part D prescription drug plans, including Medicare Advantage plans that offer Part D, must provide coverage that is equal to or better than the standard Part D benefits.

How Much Does Medicare Part D Cost?

Premium

The monthly premium varies by plan. Medicare Advantage (Part C) plans often have lower premiums than Original Medicare (Parts A and B), and some even offer a $0 monthly premium.

Deductible

Some Part D plans have a deductible and others do not. Plans that include a Part D deductible require you to pay for your prescriptions before the plan starts to cover its share. Once you reach your deductible, you then pay only your copay or coinsurance.

Copays and coinsurance

Copays and coinsurance will also vary from plan to plan. When you meet certain dollar limits on Part D drug expenses, you’ll move through the different Part D coverage stages and pay different copays and coinsurance amounts.

The Advantage of KelseyCare Advantage

Medicare Advantage plans like KelseyCare Advantage can provide additional coverage to give you peace of mind. However, not all Medicare Advantage plans are created equal, especially when it comes to the quality of care you receive. At KelseyCare Advantage, we put your health first by providing connected, coordinated care. Our doctors and hospitals work together to coordinate your care with a focus on prevention and your overall wellbeing. You'll have access to 1,000+ physicians and providers in more than 65 specialties at locations across Greater Houston. No referrals are needed to see Kelsey-Seybold providers, including orthopedics, cardiology and neurology.

We encourage you to speak to one of our local representatives to discuss plan coverage options. Please call 713-442-5646.