Medicare Prescription Drug plans are offered by private insurance companies and cover your prescription drug costs for covered medications.

You can choose to receive this coverage in addition to:

  • Original Medicare (Part A and Part B)
  • Original Medicare (Part A and Part B) with a Medigap Plan

Part D coverage is generally included in most Medicare Advantage (Part C) plans.

Costs

Premium Most Part D plans require a monthly premium.
Deductible Some plans have deductibles.
Copays Many Part D plans require that you pay a fixed copay each time you fill a prescription.
Coinsurance

Some Part D plans require that you pay a percentage (coinsurance) of a medication’s cost every time every time you fill a prescription.

Coverage Gap

Although plan designs can vary, most Part D plans have a cost sharing component commonly known as a coverage gap or “donut hole.” The coverage gap is a temporary limit where you are responsible for all of your drug costs until you reach the plan’s annual out-of-pocket limit. After you reach that limit, you will pay only a small share of your prescription costs for the remainder of the year.

Limits

Most Part D plans have “formularies,” which are lists of covered prescription drugs. They also have networks of approved pharmacies in your area.

Things to Consider

  • Costs for Part D plans can vary, so choose a plan that meets your needs and budget.
  • Part D premiums may change each year. You will be notified of these changes in the fall prior to the annual Open Enrollment Period.
  • Medicare Part D has a low-income subsidy program, and Medicare beneficiaries may qualify for financial assistance with the cost of their medications based upon their income and assets.

Enrollment

Learn more about Prescription Drug Coverage (Part D) enrollment.


Initial Enrollment Period

The Initial Enrollment Period is a limited window of time when you can enroll in Original Medicare (Part A and/or Part B) when you are first eligible. After you are enrolled in Medicare Part A or Part B, you can select other coverage options like a Prescription Drug Coverage (Part D) plan from approved private insurers. After this period has ended, you can add or change your coverage during the Open Enrollment Period.

When to Enroll

When you are first eligible, your Initial Enrollment Period for Medicare Part A and Part B lasts seven months and starts when you qualify for Medicare, either based on your age or an eligible disability.

Individuals Aged 65 or Older

Your Initial Enrollment Period is based on the month in which you turn 65. It begins three months before your birth month and extends until three months after your birth month.

Graphic demonstrating the 7 month window for the Initial Enrollment Period

Example: If you are born on June 18, 1952, your Initial Enrollment Period is from March 1, 2017 until September 30, 2017.

Individuals Aged Under 65 with an Eligible Disability

Your Initial Enrollment Period is based on when you began receiving Social Security or Railroad Retirement Board (RRB) disability benefits. It begins the 22nd month after you began receiving benefits and continues until the 28th month after you began receiving benefits.

Graphic demonstrating the 7 month window for the Initial Enrollment Period

Example: If you are began receiving disability benefits in January 2015, your Initial Enrollment Period is from November 1, 2016 until May 31, 2017.

How to Enroll

You must be entitled to Part A or enrolled in Part B, and you must live in the designated geography of the plan you want to enroll in before joining a Medicare Part D plan. Contact your local Blue Cross Blue Shield company for help choosing a Medicare Part D plan and getting enrolled.

Open Enrollment Period

October 15 through December 7

Open enrollment runs from October 15 through December 7 and it provides an annual opportunity for Medicare-eligible consumers to review and make changes to their Medicare coverage. This includes the opportunity to select or make changes to Prescription Drug Coverage (Part D). However, if you elect to receive Part D coverage after your Initial Enrollment Period window closes, a late enrollment penalty may be added to your premium.

Download the Medicare Advantage (Part C) and Prescription Drug Plans (Part D) guide to find the coverage options offered by your local Blue Cross Blue Shield company.

Medicare overview information on this website was developed by the Blue Cross and Blue Shield Association to help consumers understand certain aspects about Medicare. Viewing this Medicare overview does not require you to enroll in any Blue Cross Blue Shield plans. To find out about premiums and terms for these and other insurance options, how to apply for coverage, and for much more information, contact your local Blue Cross Blue Shield company. Each Blue Cross Blue Shield company is responsible for the information that it provides. For more information about Medicare including a complete listing of plans available in your service area, please contact the Medicare program at 1-800-MEDICARE (TTY users should call 1-877-486-2048) or visit www.medicare.gov.

Medicare has neither reviewed nor endorsed this information.

The Blue Cross Blue Shield Association is an association of 36 independent, locally operated Blue Cross and/or Blue Shield companies.