Part D (Medicare drug coverage)

If you chose Original Medicare and want to add drug coverage, you can join a separate Medicare drug plan. Medicare drug coverage is optional. It’s available to everyone with Medicare.

Most Medicare Advantage Plans include Part D coverage. In most types of Medicare Advantage Plans, you can’t join a separate Medicare drug plan. What types of plans let me join a separate Medicare drug plan?

Plans cover a variety of brand-name and generic prescription drugs. Each plan has a list of covered drugs, called a “formulary,” that can vary in cost and specific drugs covered.

• Most plans have a monthly premium that you pay in addition to your Part B premium. You’ll also pay other costs when you get prescriptions.

• Plans divide the covered drugs on their formulary into groups called "tiers" based on cost. A drug in a lower tier will cost less than a drug in a higher tier.

Avoid the penalty
You may pay a Part D late enrollment penalty if you don’t join a Medicare drug plan when you first get Medicare and go 63 days or more without creditable drug coverage

. The penalty goes up the longer you wait to join a plan. In most cases, you pay this monthly penalty for as long as you have Part D coverage, even if you switch plans.

How much is the Part D penalty?

You’ll pay an extra 1% for each month (that’s 12% for each year) you could have joined a Part D plan, but didn’t. The penalty is added to your monthly premium. It’s not a one-time late fee – you’ll pay the penalty each month for as long as you have Part D coverage.

You won’t have to pay a penalty if you get Extra Help, or if you have creditable drug coverage. This is other prescription drug coverage that provides the same value as Medicare Part D. It might be drug coverage from a current or former employer or union, individual health insurance coverage, or other federal or state program, like TRICARE, VA, Indian Health Service, or FEHB.

If you have drug coverage that’s not Medicare drug coverage (Part D), that organization has to tell you each year if it’s creditable drug coverage.

• If the coverage is creditable, join a Medicare drug plan within 63 days of when that coverage ends (or it’s no longer creditable) to avoid the penalty.

• If the coverage isn’t creditable, join a Medicare drug plan when you first get Medicare to avoid the penalty.

Things to consider when choosing to add drug coverage

Do I already have drug coverage?
If you have other “creditable drug coverage,” you can wait and join a Medicare drug plan later without a penalty, as long as you don’t go 63 days or more in a row without it.

Contact your plan to find out if your drug coverage is creditable. Talk to your current plan provider before you make any changes. In some cases, joining a Medicare drug plan might cause you and your family to lose employer or union coverage.

Do I need drug coverage?
Even if you don’t take any or many drugs now, you still may want to join a Medicare drug plan to avoid being without coverage or paying a lifetime penalty later.

What if I join a Medicare Advantage Plan that includes drug coverage?
If you join a Medicare Advantage plan that includes drug coverage, you generally can’t join a separate Medicare drug plan. If you join a Medicare Advantage Plan that doesn’t have drug coverage, in most cases you won’t be able to add a separate Medicare drug plan.

Click on the button below to learn more about the extra help program to reduce the cost of your prescriptions drugs. *restrictions apply