Medicare Part D Coverage | Part D Costs | Medicare Made Clear

Medicare Part D is prescription drug coverage. It helps pay for the medications your doctor prescribes.

Original Medicare (Parts A and B) does not cover prescription drugs. Many people who choose Original Medicare add a prescription drug (Part D) plan or choose a Medicare Advantage plan that includes Part D. 

In general, you may enroll in a Part D plan if you are entitled to Medicare Part A or if you are enrolled in Medicare Part B. In addition, you must live in the service area of a Part D plan.

What Does Medicare Part D Cover?

Medicare Part D Plans are required to cover certain common types of drugs, but each plan may choose which specific drugs it covers. The drugs you take may not be covered by every Part D plan. You need to review each plan’s drug list, or formulary, to see if your drugs are covered.

What does Medicare part D cover

Prescription drug plans do not cover:

  • Drugs that are not on the plan’s drug list
  • Drugs that are covered under Part A or Part B
  • Drugs that are excluded by Medicare

Medicare Prescription Drug Plans (Part D)

You don’t get prescription drug coverage with Medicare Parts A & B alone. Learn about Part D prescription drug plans and when you should enroll to avoid Medicare’s late enrollment penalty.

Don't miss your Part D enrollment date!

Medicare Part D charges a premium penalty if you don’t sign up when you’re first eligible, unless you qualify for a Special Enrollment Period.

Learn More >

What Does Medicare Part D Cost?

The insurance companies that offer Medicare Part D drug plans and Medicare Advantage (Part C) plans with drug coverage set their own prices, but the types of costs they include are similar. The table below shows the types of costs that plans may apply.

Part D plan premiums and cost sharing can vary widely, even for similar coverage. You need to review plan details carefully.

Premium
Per month Plan premiums vary. You still pay the Part B premium to Medicare (and the Part A premium, if you have one). 
Deductible
Per year  Some plans charge an annual deductible, and some don’t. 
Co-payment
Most new prescriptions and refills  Some plans charge co-pay each time you fill a prescription. 
Co-insurance
Some new prescriptions and refills  Some plans charge a percentage of the cost when you fill a prescription.

The Part D donut hole is going...going...

The Part D coverage gap is closing. By 2020, Medicare members will pay only 25% of the cost for covered brand name and generic drugs during the coverage gap stage.

How Medicare Part D Cost Sharing Works

Medicare Part D has different stages of cost sharing until you reach a set limit on out-of-pocket costs for the year. The limit is $4,020 in 2020. After that, your plan pays most of the cost of your drugs for the rest of the year.

Co-pays, co-insurance amounts and your plan deductible, if any, count as out-of-pocket costs. Premium payments do not.

Part D cost-sharing stages are explained below. The costs shown are for 2020. You may not go through every stage in any given year. If you get Extra Help from Medicare for Part D costs, the coverage gap stage doesn’t apply to you.

Annual Deductible:

  • You pay for your drugs until you reach the deductible amount set by your plan.
  • Not all Part D plans have a deductible.
  • If your plan does not have a deductible, your coverage starts with the first prescription you fill.

Initial Coverage:

  • You pay a copay or coinsurance and the plan pays the rest.
  • You stay in the stage until your total drug costs reach $4,020 in 2020.

Coverage Gap (Donut Hole):

  • You pay 25% of the costs for generic and brand name drugs in 2020.
  • You stay in the stage until your total out-of-pocket costs reach $6,350 in 2020.

Catastrophic Coverage:

  • You pay a small copay or coinsurance amount.
  • You stay in this stage for the rest of the plan year.

Words with Peter: Prescription Drug Coverage Gap

What exactly is the “prescription drug coverage gap,” also known as “the donut hole”? Is there a way to avoid falling into the gap? Learn more.

Each Part D plan is different, but these stories may help you understand how cost sharing might work and the savings that may be possible.

Meet Helen

Meet Helen

Helen is fairly healthy. She takes two drugs to manage her cholesterol, which is in good control.

Learn more about Helen...
Meet Enrico

Meet Enrico

Enrico has a number of chronic conditions. He takes several medications every day.

Learn more about Enrico...

Get help choosing a plan.

You have a lot of choices with Medicare. You need to think beyond just Parts A, B, C and D.

Learn More >
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More plans. More coverage.

Don’t wait to find a plan.  See UnitedHealthcare plans in your area at UHCMedicareSolutions.com or call UnitedHealthcare 7 days a week from 8 a.m.- 8 p.m. local time at 1-866-584-6886 TTY:711.

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