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Why Medicare Part D – Is It Necessary?

Medicare Part D isn’t for everyone. Some often times ask, Is it necessary to have when you turn 65? The short answer is “No.”

Beautiful older woman with gray hair and pink turtleneck looking at camera.

You can get help paying for medications with a Medicare prescription drug plan under Medicare Part D. The coverage is optional and offered by private insurance companies approved by Medicare. Although benefits vary from plan to plan, all Medicare prescription drug plans must provide the minimum coverage required by the Centers for Medicare and Medicaid Services (CMS).

Medicare Part D is technically voluntary coverage; you aren’t required to enroll in a plan. However, if you go without prescription drug coverage before you enroll in a plan, you may pay a late penalty with your monthly premium. If you have prescription drug coverage through an employer group or retiree plan, you don’t have to enroll in a Medicare Part D plan until your coverage ends.

Under Medicare Part D, prescription drug plans are available from private, Medicare-approved insurance companies, so benefits and cost-sharing structures differ from plan to plan. However, the Center for Medicare and Medicaid Services (CMS) sets minimum coverage guidelines for all Part D plans. These rules require all plans to cover medications to treat most illnesses and diseases.

Each Medicare prescription drug plan uses a formulary, which is a list of medications covered by the plan and your costs for each. Most plans use a tiered copayment system. Prescription drugs in the lowest tiers, usually generic medications, have lower copayments. Brand-name and specialty medications in the higher tiers cost more out-of-pocket.

Medicare Part D only covers prescription drugs that are FDA approved; whereas, experimental medications are generally not covered.

Many Medicare Advantage plans include prescription drug coverage. If you enroll in a plan with Part D included, you typically won’t pay a separate premium for the coverage. You generally pay one monthly premium for Medicare Advantage. You may, however, have a separate Part D deductible.

One thing to keep in mind, Medicare supplement insurance plans won’t pay for any Part D prescription costs.

You can enroll in a plan at any time during your Medicare Initial Enrollment Period, which starts three months before your 65th birthday month, includes your birthday month, and extends for three additional months. If you get Medicare because of a disability, you can generally enroll in Medicare Part D after you are on Social Security disability for 24 months.

You can make changes to your prescription drug coverage each year during the Fall Open Enrollment Period (October 15th through December 7th). If you get Medicare Part D as part of your Medicare Advantage plan, you can also make changes during the Medicare Advantage Open Enrollment Period which runs from January 1st through March 31st.

For more information on enrolling into a Medicare D prescription drug plan, call our office today and one of our licensed Medicare agents will help you navigate through the ABCD’s of Medicare. Call 1-877-651-7526 TTY: 711 or email:

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