Medicare Part D

What distinguishes Part D from the other Medicare Parts?

Other Medicare Parts are centered on your medical bills. Part D focuses on the medications prescribed to you. Medicare Part D does not automatically come with your other Medicare policies, unless you have Medicare Advantage. Part D is something you must enroll in separately.

You can get Medicare Part D during the Initial Enrollment Period (the three months before your 65th birthday to the three months after) or the Open Enrollment Period (October 15 to December 7).

What does it cover?

Medicare Part D is required to offer coverage for at least two prescription medications in the six medication categories.

These categories are:

  • Antidepressants
  • Anticancer
  • Immunosuppressants
  • HIV/AIDS medications
  • Antipsychotics
  • Anticonvulsants

The list of all of the medications covered constitutes the formulary.

The amount you pay relates to the tier your medication is in. There are four tiers: Tier 1, 2, 3, and the Specialty Tier. These range from lowest to highest copayments. Tiers are determined by the type of medication – a generic medication won’t cost you as much in copayments, as the majority of generic medications are in Tier 1.

Tier 2 medications cost more than Tier 1, but not as much as Tier 3 or the Specialty Tier. Tier 2 prescriptions are typically brand-name, yet preferred medications.

Tier 3 has the second-highest copayment. These are medications which are brand-name, but not preferred.

The Specialty Tier has the most expensive copayments. This pertains to Medications that cost the most to begin with.

We Have You Covered.


What does it not cover?

Medicare Part D won’t cover anything that is used for cosmetic reasons, such as weight loss drugs. This plan also does not cover medications for fertility or erectile dysfunction. Multivitamins, cough medicines, and benzodiazepines are also excluded from the Medicare Part D formulary.

For more information about what prescription drug coverage you can get with Medicare Part D, call me today at (407) 924-8109. You can also email me at dale@medicareplans4us.com