Part D Prescription Drug Coverage

An Important Option if You’re New to Medicare

Many people who are eligible for Medicare take one or more prescribed medications. Part D prescription drug coverage can help with these costs.

Part D is available as a standalone option or as part of a Medicare Advantage (Part C) Prescription Drug plan. It is provided by companies with a Medicare contract, such as Blue Cross and Blue Shield of Texas. Many Medicare beneficiaries pair a standalone Part D plan with a Medicare Supplement Insurance plan to help complete their Medicare coverage.

Part D Enrollment

You may enroll in a Part D prescription drug plan at certain times, such as when you turn 65 or when you retire. To be eligible for Part D, you must be entitled to Medicare Part A and/or enrolled in Medicare Part B.

Even if you don’t need it at enrollment time, it’s a good idea to select Part D when you first become eligible. Otherwise, you may have to pay a penalty if you decide you want this important coverage later.

How Drug Tiers Work

In Part D plans, drugs are placed into tiers. The costs for drugs in each tier vary. Generally, drugs on lower-number tiers cost less. Each Part D plan is different, and the number of tiers and the medications they cover vary. So, it’s important to carefully check the coverage of any drug plan you are considering before you enroll.

The Part D Coverage Gap

Depending on your prescription drug usage, you may reach a coverage gap during any given year. This is sometimes called the “donut hole”. It begins after the costs of your covered medications reach an annual limit set by the government. Medicare beneficiaries who reach the coverage gap are responsible for paying the costs of their prescriptions during the gap period. For example, during the coverage gap in 2020, Medicare members paid only 25% of the cost for covered brand name and generic drugs.