prescription drug plan (Part D)

Medicare Part D is a Prescription Drug Plan administered by private insurance companies and regulated by the federal government.  Medicare beneficiaries can enroll in a prescription drug plan if they have Part A and/or Part B.  Beneficiaries may either buy a standalone plan or get it through a Medicare Advantage plan.

Most Medicare drug plans have a coverage gap (also called the "donut hole").  Once you and your plan have spent $4,020 on covered drugs in 2020, you're in the coverage gap. This amount may change each year.  Once you've spent $6,350 out-of-pocket in 2020, you're out of the coverage gap.  This amount may change each year. Once you get out of the coverage gap, you automatically get "catastrophic coverage."   If you should spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year, you pay 5%.

Each Plan D stand alone policy or prescription drug plan under Part C (Medicare Advantage Plans with Prescription Drug Coverage - "MAPD") covers most prescription drugs found in the US.  Each plan that offers prescription drug coverage through Medicare Part D must give at least a standard level of coverage set by Medicare. Plans can vary the list of prescription drugs they cover (called a formulary) and how they place drugs into different "tiers" on their formularies.