What Is Medicare Part D Prescription Drug Coverage?

Medicare Part D plans help cover the cost of prescription medications. Whether you take a few prescriptions or many, these plans can significantly reduce your out-of-pocket drug expenses. At Schatz Benefits, we'll help you review your medications, compare available plans, and choose coverage that makes sense for your health and budget.

What's Included in Medicare Part D Plans

Medicare Part D plans are offered by private insurance companies and vary by:

Most plans cover both generic and brand-name medications across multiple drug tiers. Our advisors will help you check your prescriptions against each plan's formulary to avoid surprises.

Elderly couple running hand-in-hand through a field with arms outstretched, smiling.
Black circle with a white check mark inside.

The list of covered drugs (called a formulary)

Black circle with white check mark.

Pharmacy networks

Black circle with a white checkmark inside, indicating a selection or completion.

Premiums, deductibles, and copayments

How Medicare Prescription Drug Plans Operate

Here's how Medicare Part D coverage generally works:

Black circle with a white checkmark, indicating completion or approval.

You pay a monthly premium for your plan.

Black circle with a white checkmark, likely representing confirmation or approval.

You may have an annual deductible before coverage kicks in.

Black circle with a white checkmark, indicating approval or completion.

You pay a portion of medication costs (copay or coinsurance) until you reach certain spending thresholds.

Black circle with a white checkmark inside, on a white background.

Once you reach the coverage gap ("donut hole"), your costs may change temporarily until catastrophic coverage begins.

We'll explain these details clearly and help you estimate your yearly medication costs.

Who Should Consider Medicare Part D?

Medicare Part D is a good fit if you:

Black circle with a white checkmark inside, indicating a selection or approval.

Have Original Medicare or a Medicare Supplement Plan (Medigap) and need drug coverage

Black circle with white checkmark.

Want to avoid late enrollment penalties for not having drug coverage

Black circle with white checkmark.

Prefer flexibility in your medical and drug plan choices

Black circle with white checkmark.

Take regular prescriptions or want protection against future medication needs

Our team will review your medications and ensure your plan covers what you need, at the pharmacies you prefer.

Common Questions About Medicare Part D Plans

  • Do I need a Part D plan if I'm not taking any prescriptions?

     It's strongly recommended. If you go without drug coverage, you could face permanent late enrollment penalties later. Many people enroll in a low-cost plan to avoid this risk.

  • Can I switch Part D plans later?

    Yes, during the Annual Enrollment Period (October 15-December 7), you can review and change your Part D plan each year.

  • How do I know if my medications are covered?

    Each plan has its own formulary. We'll help you check your prescriptions and preferred pharmacies to find the best match.

  • What is the Medicare "donut hole"?

    The "coverage gap" or donut hole refers to a temporary limit on what the plan covers for drug costs. We'll help you understand how it works and if you're likely to be affected.

  • Are Part D plans included in Medicare Advantage?

    Some Medicare Advantage plans include drug coverage, but if you have Original Medicare or a Medigap plan, you'll need a separate Part D plan.