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What Is Medicare Part D?

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What Is Medicare Part D?

- What else should you know about Medicare Part D prescription drug plans?

- Who’s eligible for a Medicare Part D prescription drug plan?


Medicare Part D is prescription drug coverage. You can enroll in a stand-alone Medicare prescription drug plan or a Medicare Advantage prescription drug plan. Both are available from Medicare-approved private insurance companies.

Medicare Part D coverage is optional, but if you don’t enroll in Medicare Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later.

Your monthly plan premium and out-of-pocket expenses for prescription drugs will vary from plan to plan.

Tip: Review your Medicare Prescription Drug Plan coverage every year to see if your plan covers the medications you need now and may need in the upcoming year.

Every Medicare prescription drug plan has a formulary — that is, a list of covered drugs. The formularies vary among plans.

Be aware that your plan may change its formulary. You may want to review the Annual Notice of Change that the plan sends you every fall to make sure it will still cover your prescription medications in the coming year.

What else should you know about Medicare Part D prescription drug plans?

No matter what type of Medicare prescription drug plan you have, here are some things to keep in mind.

  • Costs before you’ve met your deductible: If the plan has an annual deductible, you generally pay the full amount of your prescription drug costs until the deductible is met.
  • Costs in the initial coverage phase: After you meet the annual deductible, you will pay a share of the costs according to the terms of your plan. Your share, which you typically pay to the pharmacy at the time of pickup, could be a flat amount (copayment) or a percentage of the total amount (coinsurance).
  • Costs in the coverage gap: If you and your plan spend a combined $4,430 in 2022 (an amount called the initial coverage limit), you’ll enter a different Medicare Part D coverage phase. During this phase, you’ll pay no more than 25% of the cost for each covered prescription. The initial coverage limit may change from year to year.
  • Costs in catastrophic coverage: Once you have paid a certain annual maximum amount out of your own pocket for covered prescription drugs, you automatically get “catastrophic coverage.” This means for the rest of that particular year, you would only pay a small copayment or coinsurance amount for prescription drugs. Medicare Part D catastrophic coverage begins when you’ve spent $7,050 in 2022. This amount may change from year to year.

Be sure to talk to your doctor to see if you are taking the lowest-cost medications available to you. Specific coverage may vary from plan to plan, so read your documentation carefully.

Who’s eligible for a Medicare Part D prescription drug plan?

Any beneficiary who is eligible for Original Medicare, Part A, and/or Part B can sign-up for a stand-alone Medicare Part D prescription drug plan. If you’d prefer a Medicare Advantage prescription drug plan, you need to have both Part A and Part B.

In either case, you must live within the plan’s service area.

You can sign up for either type of Medicare prescription drug plan only during certain enrollment periods.

Medicare information is everywhere. What is hard is knowing which information to trust. Because Medicareprofessionaladvisors are following the CMS regulations, you can rest assured you’re getting accurate information so you can make the right decisions for your coverage.

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Medicare Parts


Medicare Part A

Part A of Medicare covers hospitalisation. Inpatient treatment, limited time in a licenced nursing facility, limited home health care services, and hospital care are all covered under Part A.


Medicare Part B

Non-hospital medical costs such as doctor's appointments, blood tests, x-rays, diabetes testing and supplies, and outpatient hospital treatment are covered by Part B benefits. For this component of the original health insurance, you pay a monthly fee.


Medicare Part C

In a health insurance plan, Medicare Advantage or Medicare Part C normally covers all forms of health insurance coverage. Private insurance businesses that have been contracted by the CMS to provide a medicare plan as an alternative to the original health insurance plan provide it.


Medicare Part D

Medicare Part D is a prescription medication coverage option. Part D health insurance is available as a stand-alone plan from private insurance firms, with monthly rates varying from one to the next. Depending on the plan you're registered in, you'll split the cost of your prescription medicines.

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  • Initial Enrollment Period – Most persons can enrol in Medicare Part A, Part B, Part C, and/or Part D for the first time within a seven-month period: three months before, three months during, and three months after they reach 65.
  • Special Enrollment Period (SEP) – Certain life circumstances, including as moving or losing current coverage, may qualify you for coverage. You usually have two months to enrol, depending on your circumstances.
  • Medicare Part C & D Annual Enrollment Period (AEP) – Every year, from October 15 to December 7, Existing Medicare beneficiaries can take advantage of this time to review and adjust their Medicare Advantage (Part C) and Medicare prescription medication plans (Part D). You cannot utilise AEP to enrol for the first time in Part A and/or Part B. The following year’s coverage begins on January 1st.
  • Medicare General Enrollment Period – Every year, from January 1 to March 31, While the majority of individuals will receive Part B coverage when they join in Medicare, this period is allocated for those who did not enrol in Part B when they initially became eligible. Coverage begins on July 1st of the following year.
  • Medicare Advantage Open Enrollment Period (OEP) – Every year, from January 1 to March 31, You can change to a different Medicare Advantage plan with or without medication coverage during this period, or move to Original Medicare and join a separate Medicare Prescription Drug plan. You cannot, however, go from Original Medicare to a Medicare Advantage plan, join a prescription drug plan while on Original Medicare, or change from one prescription drug plan to another prescription drug plan while on Original Medicare.