What is Medicare Part D?
About Medicare Part D
Original Medicare (Part A and Part B) only covers prescription drugs you receive during a hospital stay or if you have outpatient surgery. Private insurers such as Anthem offer standalone Medicare Part D prescription drug plans so you can make sure your medications are covered.
What Does Medicare Part D Cover?
Part D is an optional insurance plan you can add to your Part A and Part B Medicare coverage. Medicare Part D covers prescription drugs, which can help you manage your budget. This is especially true if you require regular medication.
Is the Medicare donut hole going away?
Yes. In previous years, you faced a coverage gap when you and your health plan spent a certain amount on your medications ($5,030 in 2024). After that you were required to pay 25% of your prescription drug costs until you reached an $8,000 annual out-of-pocket limit. Starting January 1, 2025, you will not pay anything for covered medications after you reach a $2,000 annual out-of-pocket limit.
Plus, the new rules make it easier to manage your out-of-pocket prescription drug costs. You can enroll in the new Medicare Prescription Payment Plan designed for members with high out-of-pocket prescription drug costs. This will let you make monthly payments versus paying the entire amount upfront. Participation in this program is completely optional. You will receive enrollment instructions from your health plan or give us a call if you have questions.
What Does Medicare Part D Cost?
Most Part D plans have deductibles, premiums, and/or copays or coinsurance for which you are responsible. Each year, the government sets a maximum limit on annual deductibles.
That limit is a good benchmark for comparing plan deductibles. Keep in mind that a plan with a $0 deductible may mean you'll pay higher copays and/or monthly premiums. Learn more about Medicare Part D costs.
What Is The Best Medicare Part D Plan?
Part D prescription drug plans cover different medications. The best Medicare Part D plan for you covers the medicines you need and take regularly.
Most plans have a formulary, which is a list of drugs the plan covers. While there are many drugs Medicare requires Part D plans to cover, you still want a plan that fits your personal prescription needs.
Just remember, there are laws that do not allow Medicare Part D insurers to cover certain categories of drugs. These include:
- Non-prescription medications
- Medications for anorexia, weight loss, or weight gain
- Drugs used to promote fertility
- Drugs for cosmetic purposes or to promote hair growth
- Cough or cold medications
- Prescription vitamins and minerals
- Drugs for sexual or ecrectile dysfunction
Are Generic Prescription Drugs Covered By Medicare Part D?
You can save money if you take generic instead of brand-name drugs. Look for Part D plans that have tiers comparing generic and brand-name drugs. Tier one and Tier two usually cover generic versions of medications that may cost you nothing or very little compared to brand medications.
What Plan Is Best When You Don’t Have Prescriptions Right Now?
If you do not currently have prescriptions for any medical needs, but still want a coverage safety net, look for a plan with a low monthly premium and/or deductible. That way, you'll have coverage if and when you need it.
Medicare Part D vs. Medicare Advantage Plans
Another way to get prescription drug coverage is through a Medicare Advantage plan (Part C) when combined with Part D (also called a Medicare Advantage prescription drug plan). Along with covering prescription drugs, many Medicare Advantage plans offer additional benefits like dental, vision, and hearing coverage.
Much like Part D plans, you can get Medicare Advantage plans through private insurers like Anthem. This gives you more plan options so you can find the plan that best fits your needs.
When Are You Eligible For Medicare Part D?
The best time to sign-up for Part D is during your Initial Enrollment Period (IEP). That’s the seven-month window that includes:
- Three months before you turn 65
- The month you turn 65
- Three months after you turn 65
You must have Medicare Part A and/or Part B before you can enroll in a Part D plan. Even if you are not taking prescription medications, it’s best to enroll in Part D as soon as you’re eligible to avoid penalties. You can still add Part D coverage after your IEP. You can make changes to your plan, including adding coverage, during the Annual Enrollment Period from October 15 to December 7 each year.
Avoiding The Medicare Part D Penalty
If you don’t sign up for a Part D plan when you’re first eligible, or you’ve gone 63 days or more without creditable drug coverage after your IEP, you’ll pay a monthly late enrollment Medicare Part D penalty for as long as you have Part D.
Applying For Medicare With Part D In Mind
When applying for Medicare, consider whether or not you need prescription drug coverage. If you decide to add a Medicare Part D plan, ask questions and review your selected plan to make sure the medicines you use are included and affordable for you.
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Why Choose Anthem?
Anthem Blue Cross and Blue Shield, a Medicare Advantage Organization with a Medicare Contract in Colorado, Connecticut, Georgia, Indiana, Kentucky, Missouri, New Hampshire, Nevada, New York, Ohio and Wisconsin, offer HMO, HMO D-SNP, HMO C-SNP, HMO I-SNP, LPPO, LPPO D-SNP and/or RPPO. Anthem Blue Cross and Blue Shield offers PDP plans in Colorado, Georgia, Indiana, Kentucky, Maine, Missouri, Nevada, New Hampshire, New York, Ohio, Virginia and Wisconsin. Anthem Blue Cross and Blue Shield HMO D-SNP and LPPO D-SNP plans contract with state Medicaid programs. Anthem Blue Cross and Blue Shield Retiree Solutions, a Medicare Organization with a Medicare Contract in New York, offers LPPO plans. Enrollment in Anthem Blue Cross and Blue Shield and Anthem Blue Cross and Blue Shield Retiree Solutions plans depend on contract renewal.