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What is Medicare Part D?

Senior man using Medicare Part D to get his prescription medicine at the pharmacy

Are prescription medicines part of your everyday health care needs? Then it’s a smart idea to include drug coverage in your health care plan. When you’re turning 65 and applying for Medicare, you can explore how Medicare Part D covers prescription drugs.

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 Part D plans so you can make sure all 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, which covers prescription drugs, can help you save money. This is especially true if you’re managing a condition that requires regular medication.

When are you eligible for Medicare Part D?

The first enrollment period for Part D is the 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

During this time, you can apply for Part D coverage along with Medicare Part A and Part B. 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.

What types of prescription medications do you take?

There are lots of Part D prescription drug plans and they cover different medications. Be sure to find a plan that 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 erectile dysfunction

Are generic versions of your prescription drugs covered?

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, but want that coverage for peace of mind?

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 have the coverage if and when you need it.

Remember, 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 penalty while you have Part D coverage. While the fee is typically only a few dollars each month, you can avoid it.

Medicare Part D versus Medicare Advantage plans

Another way to get prescription drug coverage is through a Medicare Advantage plan or Part C. Along with covering prescription drugs, many Medicare Advantage plans offer extra benefits that help you save more money in the long run.

You can choose Part C or Part D, but you can’t have both at the same time. That’s why many people choose Part C plans, as they cover drugs and a lot more. Medicare Advantage plans may also include:

  • Routine dental care including cleanings, X-rays and dentures
  • Routine vision care including contacts and glasses
  • Routine hearing care including hearing aids
  • Fitness benefits including exercise classes

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.

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.

Explore all your options for Medicare prescription drug plans, including comprehensive Medicare plans.

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Georgia: Blue Cross Blue Shield Healthcare Plan of Georgia, Inc.  In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWI), which underwrites or administers the PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare Health Services Insurance Corporation (Compcare) underwrites or administers the HMO policies and Wisconsin Collaborative Insurance Company (WCIC) underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem websites constitutes your agreement with our Terms of Use.