Unlike Original Medicare, which has existed since the 1960s, you didn’t grow up with Medicare prescription drug plans. These plans – also known as Medicare Part D – have only been around since 2006. Naturally, you may still have questions, like “do I need Medicare Part D?”
Medicare Part D prescription drug coverage is optional. In spite of this, most Medicare beneficiaries – particularly those with chronic conditions – will still want to get Medicare Part D coverage.
What Are Medicare Part D Prescription Drug Plans?
Medicare Part D is a specific type of private, government-regulated prescription drug plan that works with your Medicare coverage. You’re eligible to enroll in a Part D plan if you receive Medicare upon turning 65. You’re also able to enroll if you sign up for Medicare due to a disability. If you delay getting Part D coverage for a while because you already had a group health plan that covered prescription drugs, you can apply for Part D when your existing coverage ends.
Is a Medicare Prescription Drug Plan Right for Me?
Most people will need Medicare Part D prescription drug coverage. Even if you’re fortunate enough to be in good health now, you may need significant prescription drugs in the future. A relatively small Part D payment entitles you to outsized benefits once you need them, just like with a car or home insurance.
You could rely on charity care or alternate drug plans, but they come without the stability and consumer protections of federally-regulated Medicare Part D plans. Government programs also provide help with Part D payments for Medicare beneficiaries with limited means.
There are a few circumstances where it doesn’t make sense to get Medicare Part D:
- If you have a Medicare Advantage policy, it may already include Part D prescription drug coverage (also called a MA-PD plan). You won’t need to look for a separate plan.
- If you have creditable coverage – equivalent prescription drug coverage like that from a large employer, TRICARE, PACE, or the VA – then you may not need Medicare Part D. You can postpone Medicare Part D enrollment without penalty for as long as you maintain your creditable coverage.
- If you’re in the end stages of a life-threatening disease and under Medicare hospice care, Medicare Part A covers medications related to the terminal condition. If you need medications for anything not related to that condition, you will need to purchase Part D coverage.
Premiums: Similarly to Medicare Part B, you’ll pay an additional adjustment to your monthly Part D premium if you listed high income on your tax returns two years ago, have substantial investments, or a sizable pension. However, delaying Part D because you must pay the higher-income beneficiary adjustments can expose you to a lifelong penalty.
Cases for Medicare Part D Prescription Drug Coverage
Americans between the ages of 65 and 69 take an average of nearly 14 different drugs per year.2
Average Beneficiary
Common chronic conditions such as multiple sclerosis, cardiovascular diseases, and respiratory illnesses have high drug costs that make having Part D a huge relief. If you have multiple chronic conditions (which apply to seven out of 10 Medicare beneficiaries), it’s probably a good idea to get Medicare Part D drug coverage.
