Overview of Medicare: Part D

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Medicare: Part D is insurance for outpatient prescription drugs — meaning medications you take yourself instead of having them administered in a hospital or doctor’s office. Medicare’s drug benefit was only added to the program in 2006, a full 40 years after Medicare began. Since then, it’s saved huge amounts of money for millions of people and allowed many to get the meds they need for the first time.

Still, you can’t gloss over the fact that Part D is a complicated benefit that takes a lot of getting used to. Here are just some of the peculiar ways it differs from other drug coverage you may have used in the past:

  • Coverage goes through four distinct phases during a calendar year, and in each phase the same drug can cost a different amount.

  • To get coverage, you must select just one private plan that provides Part D drugs out of many plans (at least 25) that are available to you.

  • Different plans cover different sets of drugs, and no plan covers all drugs.

  • Plans set their own co-pays for each drug, and these amounts can vary enormously, even for the same drug.

  • Plans may require you or your doctor to ask permission before they cover certain drugs or to try a less expensive version before they cover the one you were prescribed.

  • Plans are allowed to change their costs and benefits or to withdraw from Medicare entirely each calendar year.

If this all sounds mystifying, you’re probably wondering how on earth anyone can possibly navigate Part D to find good drug coverage. But yes, it’s possible! Just do your research carefully.

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