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 plans are a specific type of private, government-regulated prescription drug coverage that works with your Medicare insurance. 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 Plan Prescription Drug Coverage
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.