Medicare does not automatically include prescription drug coverage. Part D is how you get it.

 

Medicare Part D is standalone prescription drug coverage offered through private insurance carriers approved by Medicare. Every Part D plan has its own formulary — a list of covered drugs — as well as its own premiums, deductibles, and copays.

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How Part D Coverage Works

Medicare Part D follows a standard benefit structure set by Medicare each year. While the specific dollar amounts change annually, the coverage phases themselves remain consistent. Understanding these phases helps you anticipate how your costs may shift throughout the year. Learn more about the current benefit model here -->

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The Coverage Phases

• Deductible Phase: Most Part D plans have an annual deductible. Until you meet that deductible, you pay the full cost of your covered prescriptions. Some plans waive the deductible for certain drug tiers — typically generic medications.

• Initial Coverage Phase: Once your deductible is met, you share costs with your plan through copays or coinsurance until your total drug spending reaches a set threshold. During this phase, both what you pay and what your plan pays count toward your progress through the benefit.

• Catastrophic Coverage Phase: After your out-of-pocket drug costs reach the annual limit — called the Maximum Out-of-Pocket (MOOP) — your plan covers the rest of your covered prescription costs for the remainder of the calendar year. This protection is an important safeguard for people with high medication needs.​

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Part D and Supplement Plans

If you are enrolled in a Medicare Supplement plan, you will need a standalone Part D plan to cover your prescriptions.

 

Part D and Medicare Cost Plans

If you are enrolled in a Medicare Cost plan, your situation depends on whether your plan includes prescription drug coverage. Most Cost plans offer drug coverage as an option — if you elected it, you do not need a standalone Part D plan. If your Cost plan does not include drug coverage, you can pair it with a standalone Part D plan. We can help you confirm what your current Cost plan includes and whether a standalone plan makes sense for you.

 

Part D and Medicare Advantage

If you are enrolled in a Medicare Advantage plan, prescription drug coverage is most likely already included. These plans are called MAPD plans — Medicare Advantage Prescription Drug plans — and they are the most common type of Medicare Advantage plan available in Minnesota.

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If your Medicare Advantage plan includes drug coverage, you do not need a standalone Part D plan. In fact, enrolling in a standalone Part D plan while on an MAPD plan may result in automatic disenrollment from your Advantage plan.

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A small number of Medicare Advantage plans do not include drug coverage — these are called MA-Only plans, designed for people who have qualifying drug coverage from another source, most commonly veterans with VA prescription benefits. 

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The Late Enrollment Penalty

Timing matters. If you go without creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period ends, you will pay a late enrollment penalty — 1% of the national base premium for every month you went without coverage. This penalty is added to your Part D premium permanently. You can delay enrolling in a Medicare Part D plan without a penalty only if you have creditable* coverage, such as from an employer, union, or VA. If that coverage ends, you must enroll in Part D within 63 days to avoid the penalty.

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*Creditable coverage means drug coverage that is at least as good as Medicare's standard Part D benefit — most employer plans qualify. If you are leaving employer coverage, confirm with your employer whether your drug coverage was creditable before your Medicare enrollment window closes.

 

Extra Help with Part D Costs

Medicare offers a program called Extra Help — also known as the Low Income Subsidy (LIS) — to help people with limited income and resources pay for prescription drug costs. You can review income thresholds at Medicare.gov -->

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What Extra Help Covers

Qualifying for Extra Help may reduce or eliminate your Part D plan's deductible, lower your copays and coinsurance for covered medications, and help with your monthly plan premium. 

 

How to Apply

Apply for Extra Help here. Or, you can apply through the Social Security Administration by phone at 1-800-772-1213 or TTY 1-800-325-0778. Medicare may automatically enroll you in Extra Help if you receive Medical Assistance or participate in a Medicare Savings Program.

 

Extra Help and Special Enrollment Periods

One of the most important benefits of qualifying for Extra Help is the enrollment flexibility it provides. People who receive Extra Help are eligible for a Special Enrollment Period (SEP) that allows them to:

• Enroll in a Part D plan outside of the standard Annual Enrollment Period

• Switch Part D plans once per calendar quarter (January through September)

• Make a final switch during the Annual Enrollment Period in the fall

This means you are not locked into a plan for the full year. If your medications change or a better plan becomes available, you have ongoing opportunities to make adjustments.

 

​​​Our Role in your Part D Coverage

Your prescriptions are one of the most important factors in choosing the right Medicare coverage. Whether you are comparing standalone Part D plans alongside a Medicare Supplement, or evaluating Medicare Advantage plans that include drug coverage, the medications you take — and how each plan covers them — should drive that decision.

We can help you compare your options, check whether your current drugs are covered under the plans available to you, and compare the costs of those drugs based on how the plan tiers them.​

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If you have a Medicare Supplement plan with separate drug coverage, due to carriers limiting agent options, standalone Part D plans are not something we hold Agent of Record status on. That means in future years, you'll want to shop and compare plans on your own during the Annual Enrollment Period for the most efficient outcomes. Plans change every year, and the best plan for your medications one year may not be the best the next.

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For clients with standalone Part D plans: We've built a step-by-step guide to help you do this confidently using Medicare.gov — including how to enter your medications, compare plans, and enroll on your own.

Medicare Supplement plan holders: Find the right standalone Part D plan — Medicare.gov Step-by-Step Guide →

 

Questions About Part D?

We're happy to help you think through your options at enrollment. Call us at 763-878-5994 or submit a contact request.

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Part D premiums, formularies, and plan availability change annually. Always verify current plan information at Medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).