Header
Flexible Content

Prescription Drug Coverage (Part D)

Medicare Prescription Drug plans are offered by private health 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 copayment 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 you fill a prescription.
Coverage Gap Although plan designs can vary, most Medicare 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 and Considerations

Limits

Most Part D plans have “formularies,” which are lists of covered prescription drugs. Part D plans 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 insurance 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.

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 Parts A or 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.

Title
When to Enroll
Description
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.
Accordion Item
FAQ Item Question
Individuals Aged 65 or Older
FAQ Item Answer

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.

Enrollment Period

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

FAQ Item Question
Individuals Aged Under 65 with an Eligible Disability
FAQ Item Answer

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 28thmonth after you began receiving benefits.

Monthly benefits

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.

File Attachments
2019 Coverage Options Download File