{"id":355785,"date":"2016-04-04T10:46:14","date_gmt":"2016-04-04T15:46:14","guid":{"rendered":"https:\/\/content.findlaw-admin.com\/ability-law\/healthcare\/medicare-medicaid\/choosing-a-medicare-part-d-plan.html"},"modified":"2025-09-08T15:54:54","modified_gmt":"2025-09-08T20:54:54","slug":"choosing-a-medicare-part-d-plan","status":"publish","type":"page","link":"https:\/\/www.findlaw.com\/healthcare\/medicare-medicaid\/choosing-a-medicare-part-d-plan.html","title":{"rendered":"Choosing a Medicare Part D Prescription Plan"},"content":{"rendered":"\n
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Medicare Part D Prescription Plan<\/h1>\n\n
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\n By Lyle Therese A. Hilotin-Lee, J.D.<\/a> | Legally reviewed by Jordan Walker, J.D.<\/a>\n | Last updated\n
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This article has been written and reviewed for legal accuracy, clarity, and style by FindLaw\u2019s team of legal writers and attorneys<\/a> and in accordance with our editorial standards<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n\n

\n \n <\/i>\n Fact-Checked\n <\/summary>\n\n
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The last updated date refers to the last time this article was reviewed by FindLaw or one of our contributing authors<\/a>. We make every effort to keep our articles updated. For information regarding a specific legal issue affecting you, please contact an attorney in your area<\/a>.<\/em><\/p>\n\n <\/div>\n <\/details>\n<\/section>\n\n\n

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Before choosing a Medicare Part D prescription drug benefit plan, take the time to\u00a0compare costs, coverage of your specific medications, pharmacy networks, and plan formularies to ensure it meets your health and budget needs. It’s important to check whether the drugs you take are covered, that\u00a0the cheapest premium isn’t the most important deciding factor, and that you\u00a0enroll during the designated enrollment period to avoid penalties.<\/i><\/p>\n\n <\/div>\n\n\n\n

Medicare Part D provides a prescription drug benefit that’s separate from traditional Medicare Parts A and B. You can enroll in Part D through standalone prescription drug plans (PDPs) or Medicare Advantage plans that include coverage for prescription drugs.<\/p>\n

Medicare Part D provides crucial coverage for medications. It saves Medicare beneficiaries from paying the high drug costs of prescription drugs. If you are facing issues related to Medicare or need help in understanding prescription drug coverage, consider speaking with a\u00a0healthcare attorney<\/a>. They can ensure that you are getting the coverage that you are entitled to under the laws of the federal government.<\/p>\n

What Is a Medicare Part D Plan?<\/h2>\n

Medicare Part D fills a gap in traditional Medicare coverage by providing prescription drug benefits. Everyone with Medicare has the option to add this coverage through insurance companies and other private companies approved by Medicare. Part D works together with your other Medicare coverage. If you have Original Medicare (Parts A and B), adding Part D gives you comprehensive coverage. If you choose\u00a0Medicare Advantage (Part C)<\/a>, most plans already include prescription drug coverage.<\/p>\n

Types of Medicare Prescription Drug Plans<\/h2>\n

There are two basic\u00a0types of Medicare Part D prescription plans<\/a>. Let’s take a look at each one to see what they offer:<\/p>\n

Prescription Drug Plans (PDPs)<\/h3>\n

PDPs are\u00a0stand-alone programs<\/a>\u00a0that focus on and cover prescription drugs only, as opposed to other\u00a0healthcare needs. People who already have Original Medicare (Part A or B) typically choose PDPs.<\/p>\n

Advantage Plans with Prescription Coverage (MA-PDs)<\/h3>\n

MA-PDs are Medicare Advantage Plans that also cover prescription drugs. They come in\u00a0four types<\/a>: HMOs, PPOs, PFFS, and Special Needs Plans (which are only for very specific groups of people). These are managed care programs that often\u00a0require you to use certain doctors and hospitals, but\u00a0offer lower costs.<\/p>\n

The type of plan you choose will\u00a0be based on the amount of money you can spend and the type of coverage you need. Take the time to do your research and find the best plan for you.<\/p>\n

Eligibility for Medicare Part D Prescription Plans<\/h2>\n

If you’re eligible for Medicare Part A (hospital coverage) or Part B (medical insurance), you are also eligible for\u00a0Medicare Part D<\/a>. Part D benefits work together with your other Medicare coverage. If you have Original Medicare (Parts A and B), adding Part D gives you coverage for medications. If you choose Medicare Advantage (Part C), most plans already include prescription drug coverage. Traditional Medicare plans often don’t cover the costs of medications.<\/p>\n

General eligibility for Medicare benefits starts when you reach 65 years old. However, you can enroll three months before your 65th birthday. There are also instances where enrollees under 65 years old can\u00a0qualify for Medicare<\/a>. You may be eligible for Medicare\u00a0under age\u00a065 if you have a disability, End Stage Renal Disease (ESRD) or ALS (amyotrophic lateral sclerosis).<\/p>\n

In most cases, you can only make changes to your Medicare drug plan during the annual enrollment period (October 15-December 7). Certain qualifying events create special enrollment periods where changes are permitted.<\/p>\n

Features of Medicare Part D<\/h2>\n

Each Part D plan’s formulary (covered prescription drugs)\u00a0provides a list of medications it covers. The list will tell you the name of the drug it covers and how much your copay is.<\/p>\n

If the medication is not on the list, you may be responsible for\u00a0the costs for that medication. You also have the option to use a\u00a0drug plan that covers it. Although there are options to apply for an exception to cover the medication you have, it is best that you pick a plan that covers your existing medication.<\/p>\n

Changes to Medicare Part D Coverage in 2025<\/h2>\n

As of\u00a0January 1, 2025<\/a>, Medicare Part D coverage underwent significant changes. This change was caused by the Inflation Reduction Act (IRA), a\u00a0prescription drug law. This law simplified prescription drug coverage and established a $2,000 annual cap on out-of-pocket spending for Medicare-covered medications. According to the HHS,, these benefit changes will reduce annual out-of-pocket medication costs by an average of 30%.<\/p>\n

Medicare Part D coverage now\u00a0consists of a three-phase benefit.<\/p>\n