Prescription Drug Coverage · Licensed Medicare Agents

Medicare Part D Prescription Drug Plans

Part D helps cover prescription drug costs, but the right setup depends on whether you have Medicare Supplement, Medicare Advantage, employer coverage, or no creditable drug coverage. The wrong choice — or no choice at all — can cost you.

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Quick Answer

What is Medicare Part D?

The short answer

Medicare Part D is prescription drug coverage for people with Medicare. It is offered by private insurance companies approved by Medicare. You can get it as a stand-alone drug plan if you have Original Medicare, or as part of many Medicare Advantage plans that include drug coverage.

Each Part D plan has its own premium, formulary, pharmacy network, copays, deductible, and coverage rules. Plans vary by ZIP code, so what is available in your area may differ from what a neighbor or family member has in a different state.

Not sure if you need a stand-alone drug plan?It depends on whether you have Original Medicare, Medicare Advantage, or employer coverage — and whether that coverage is creditable.

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Stand-Alone Part D

Do I need a separate Part D plan?

You may need a stand-alone Medicare Part D plan if you have Original Medicare and want prescription drug coverage. This is especially true if you pair Original Medicare with a Medicare Supplement plan.

Medicare Supplement plans do not include prescription drug coverage, so most people who choose a Medigap plan also enroll in a separate Part D prescription drug plan. These two coverages are designed to work together.

If you have a Medicare Advantage plan, many of those plans already include drug coverage. And if you have creditable drug coverage through an employer or union, you may be able to delay Part D enrollment without a penalty — but you need written confirmation to be safe.

Choosing Medicare Supplement?Review Part D at the same time. A licensed agent can help you compare both.

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Coverage Type
Part D Need
Original Medicare + Medicare Supplement
Usually needs a separate Part D plan
Medicare Advantage (MAPD)
Drug coverage often included — verify your plan
Medicare Advantage (HMO/PPO, no drug coverage)
May need a stand-alone Part D plan
Employer or retiree coverage
May or may not be creditable — get written confirmation before delaying
No drug coverage
Enroll in Part D or risk a permanent late enrollment penalty

Enrollment

How do I buy a Medicare Part D plan?

To compare and enroll in Medicare Part D, you can use the Medicare.gov Plan Finder, call 1-800-MEDICARE, enroll directly through a private insurance company, or work with a licensed Medicare agent. Before comparing plans, gather everything you will need.

  1. 1 Gather your Medicare card number and your Part A and Part B effective dates.
  2. 2 Write down each prescription, dosage, and how often you refill it.
  3. 3 Choose your preferred pharmacy — retail, mail-order, or both.
  4. 4 Compare monthly premiums, annual deductibles, copays, and drug tier placements.
  5. 5 Verify your drugs are on the plan's formulary and check for prior authorization or step therapy requirements.
  6. 6 Enroll during the right enrollment period for your situation.

Want help comparing drug plans?A licensed agent can walk through your medications and preferred pharmacy with you.

Get Help Comparing Drug Plans

Ways to Enroll

Four ways to enroll in Part D

Online — Medicare.gov Plan Finder

Enter your ZIP code and medication list to compare plans available in your area. Recommended as your starting point.

By Phone — 1-800-MEDICARE

Call 1-800-633-4227 to speak with Medicare directly. Available 24 hours a day, 7 days a week.

Through a Private Insurer

Enroll directly through a Medicare-approved insurance company such as Humana, UnitedHealthcare, or others available in your area.

Through a Licensed Medicare Agent

A licensed agent can compare plans across carriers based on your specific medications, pharmacy, and budget — at no direct cost to you.

Formulary and Coverage

How do I know if my drugs are covered?

Part D plans cover prescription drugs listed on the plan's formulary — the list of covered drugs. Plans group drugs into tiers that determine your cost-sharing. Higher tiers generally mean higher copays. Plans can also require prior authorization, step therapy, or quantity limits before covering certain drugs.

Part D plans generally do not cover drugs prescribed for weight loss, fertility, erectile dysfunction, or cosmetic purposes. They also do not cover prescription vitamins and minerals, non-prescription drugs, or drugs already covered under Medicare Part A or Part B.

Because every plan has a different formulary, a drug that is covered on one plan may be on a different tier — or not covered at all — on another plan in the same area.

What to check before you choose

  • Is each drug on the formulary?
  • What tier is each drug on — and what is the copay?
  • Is there an annual deductible before coverage starts?
  • Which pharmacies are preferred — and what does that mean for your costs?
  • Are mail-order prices different from retail?
  • Are there prior authorization, step therapy, or quantity limit requirements?
  • What happens if a medication is added or changed mid-year?
  • What is the estimated total annual cost — not just the monthly premium?

Formularies change every year.A review of your medications before Annual Enrollment can prevent unexpected costs.

Review My Drug Coverage

Medicare Supplement + Part D

How does Part D work with Medicare Supplement?

Medicare Supplement plans do not cover outpatient prescription drugs. Medigap policies sold after January 1, 2006 cannot include prescription drug coverage. That means if you choose Original Medicare with a Medicare Supplement plan, you will need a separate Part D plan to have prescription drug coverage.

This is why Medicare Supplement and Part D should be reviewed together — not separately. A Medicare Supplement plan may help reduce certain medical out-of-pocket costs, while Part D fills the prescription drug gap. Together, they represent a complete Original Medicare strategy for many people.

Choosing Medigap? Don't forget Part D.

A licensed Lehigh Partners agent can help you compare Medicare Supplement options and review Part D drug coverage at the same time — so you see the full cost picture before you decide.

Compare Medicare Supplement Options Schedule a Medicare Review

Medicare Advantage

Do I need Part D if I have Medicare Advantage?

Many Medicare Advantage plans include prescription drug coverage. These are often called MAPD plans — Medicare Advantage Prescription Drug plans. If your Medicare Advantage plan already includes drug coverage, you generally should not add a separate stand-alone Part D plan.

If you want your medical and drug coverage bundled into one plan, Medicare Advantage may be worth comparing. If you prefer Original Medicare with broader provider access, pairing a Medicare Supplement plan with a stand-alone Part D plan is the more common path.

Not every Medicare Advantage plan includes drug coverage. Some plans — such as certain Medical Savings Account plans — do not. If your plan does not include drug coverage and you want it, a stand-alone Part D plan may be an option.

Comparing Advantage vs Supplement?Understanding how drug coverage fits into each path is part of making the right call.

Compare Medicare Advantage vs Supplement

Two paths, one question

How drug coverage fits each Medicare path

Original Medicare + Medicare Supplement

Medicare Supplement does not include drug coverage. A separate Part D plan is usually needed.

Medicare Advantage (MAPD)

Drug coverage is typically included. A separate Part D plan is usually not allowed or needed.

Medicare Advantage (no drug coverage)

Rare, but it exists. You may be able to join a stand-alone Part D plan. Verify with the plan.

Enrollment Windows

When can I enroll in Part D?

You can enroll in a Part D plan when you first become eligible for Medicare. After that, changes are generally limited to specific enrollment periods. Missing your Initial Enrollment Period without creditable coverage can result in a permanent late enrollment penalty.

First Chance

Initial Enrollment Period

The 7-month window around when you first become eligible for Medicare — typically around your 65th birthday. This is the most important window to know.

Each Year

Annual Enrollment Period

October 15 through December 7 each year. You can join, switch, or drop a Part D plan. Changes take effect January 1 of the following year.

Life Events

Special Enrollment Period

Triggered by qualifying events such as losing creditable drug coverage, moving to a new service area, or qualifying for Extra Help. Dates and length vary by event.

Not sure which window applies to you?A licensed agent can help you figure out where you are in the enrollment calendar.

Check My Enrollment Window

Delaying Part D

Can I delay Part D enrollment?

You can delay Part D enrollment without a penalty if you have creditable prescription drug coverage. Creditable coverage means your current drug plan is expected to pay, on average, at least as much as standard Medicare Part D coverage.

Common sources of creditable coverage include employer or union drug plans, TRICARE, and VA drug coverage. However, you must have written confirmation that the coverage is creditable. Do not assume — ask for a notice in writing and keep it with your records.

If you are still working past 65 and plan to delay Medicare, talk to your employee benefits administrator. They can confirm whether your employer drug plan qualifies as creditable and document it for you.

Delaying Part D safely

To delay Part D without a penalty

  • Confirm you qualify for a Medicare Special Enrollment Period when coverage ends.
  • Get written confirmation from your plan that coverage is creditable — do not rely on a verbal confirmation.
  • Enroll in a Part D plan within 63 days of losing creditable drug coverage.
  • Keep all creditable coverage notices in a safe place in case Medicare asks later.

Still working past 65?A review can confirm whether your employer coverage qualifies and what your options are when it ends.

Verify My Coverage Status

Late Enrollment Penalty

What happens if I go without Part D?

If you go 63 or more consecutive days without Medicare drug coverage or other creditable prescription drug coverage after your Initial Enrollment Period ends, you may owe a Part D late enrollment penalty when you do join a plan.

The penalty is calculated as an extra 1% of the national base beneficiary premium for each full month you went without coverage. That percentage is added to your monthly Part D premium — and in most cases, it lasts for as long as you have Medicare drug coverage. It does not go away after a set number of years.

Example

If your Initial Enrollment Period ended in June and you do not enroll in Part D until a plan starting in November — four months later — your penalty would be approximately 4% of the national base beneficiary premium added to your monthly Part D premium for as long as you have drug coverage.

The Part D penalty is permanent in most cases. The longer you wait without creditable coverage, the higher it can get.

Want to estimate your potential penalty?Use the calculator to see what a delay might cost before it becomes permanent.

Use the Part D Penalty Calculator

Annual Review

Do I need to review my drug plan every year?

Yes. Part D plans can change premiums, deductibles, formularies, pharmacy networks, drug tier placements, and coverage rules from one year to the next. A plan that fits well this year may cost significantly more next year if your medications move to a higher tier or your preferred pharmacy leaves the network.

Every fall, Medicare-approved drug plans send an Annual Notice of Change listing what is changing for the coming year. Many people never read it — but those changes can add up to hundreds of dollars in unexpected costs if you stay in a plan that no longer fits.

The Annual Enrollment Period — October 15 through December 7 — is your opportunity to review and switch drug plans without penalty.

Has your plan changed this year?A quick review before December 7 could save you money in the year ahead.

Schedule an Annual Drug Plan Review

Annual enrollment checklist

Review each year before December 7

  • Updated medication list and dosages
  • Preferred pharmacy still in network
  • Monthly premium changes
  • Annual deductible changes
  • Drug tier and copay changes
  • Formulary — are all drugs still covered?
  • Prior authorization or step therapy changes
  • Total estimated annual drug cost across all plans available

Why Work With Us

Part D help without call-center pressure

Lehigh Partners Senior Benefits helps you compare Medicare Supplement, Medicare Advantage, and Part D options in the right order — starting with your medications, doctors, and budget.

Licensed Medicare agents
Medicare Supplement + Part D reviews together
Medicare Advantage drug plan comparisons
Part D penalty guidance and avoidance
Annual drug plan reviews before AEP
No obligation to enroll

Common Questions

Medicare Part D questions people ask before enrolling

Medicare Part D is prescription drug coverage for people with Medicare. It is offered by private insurance companies approved by Medicare. You can get it as a stand-alone drug plan if you have Original Medicare, or through many Medicare Advantage plans that include drug coverage. Each plan has its own premium, formulary, pharmacy network, copays, deductible, and coverage rules.
It is worth considering even if you take no prescriptions right now. If you go 63 days or more without Medicare drug coverage or other creditable prescription drug coverage after you are eligible, you may owe a permanent late enrollment penalty when you do join a Part D plan — and that penalty can last as long as you have drug coverage.
No. Medicare Supplement plans sold after 2005 do not include prescription drug coverage. Original Medicare also does not cover most outpatient prescriptions. If you choose Original Medicare with a Medicare Supplement plan, you will usually need to enroll in a separate Part D plan to have prescription drug coverage.
Yes. Many people who choose Original Medicare with a Medicare Supplement plan also enroll in a separate stand-alone Part D prescription drug plan. This is a common and often recommended combination. A Medicare Supplement plan may help with certain medical out-of-pocket costs, while Part D covers prescription drugs. A licensed agent can help you review both together.
Many Medicare Advantage plans include prescription drug coverage. These are often called MAPD plans. If your Medicare Advantage plan includes drug coverage, you generally should not also enroll in a separate stand-alone Part D plan. Some Medicare Advantage plan types do not include drug coverage — if yours does not, a stand-alone Part D plan may be an option.
You can enroll when you first become eligible for Medicare during your Initial Enrollment Period. After that, changes are generally limited to the Annual Enrollment Period — October 15 through December 7 each year — or a Special Enrollment Period triggered by qualifying life events such as losing creditable drug coverage or moving.
Creditable prescription drug coverage means your current drug coverage is expected to pay, on average, at least as much as standard Medicare Part D coverage. If you have creditable coverage through an employer, union, TRICARE, or VA, you may be able to delay Part D without a late enrollment penalty — but you need written confirmation. If that coverage ends, you generally have 63 days to enroll in a Part D plan without penalty.
If you go 63 consecutive days or more without Medicare drug coverage or other creditable prescription drug coverage after you are eligible, you may owe a Part D late enrollment penalty. The penalty is added to your monthly drug plan premium and in most cases lasts for as long as you have Medicare drug coverage — it does not expire after a certain number of years.
The Part D late enrollment penalty is an extra 1% of the national base beneficiary premium for each full month you went without Part D or other creditable drug coverage after your Initial Enrollment Period ended. The penalty is added to your monthly Part D premium. For example, if you enrolled four months after your window closed, your penalty would be approximately 4% added to your monthly premium — permanently. You can use the Part D Penalty Calculator to estimate your potential penalty.
Yes. A licensed Lehigh Partners Senior Benefits agent can help you compare Part D options alongside Medicare Supplement and Medicare Advantage plans. We review your medications, dosages, preferred pharmacy, and budget before making any recommendations. There is no pressure and no obligation to enroll. We do not offer every plan available in every area — you can also contact Medicare.gov or 1-800-MEDICARE for information on all plans in your area.
Schedule a Medicare Review

Ready to compare your Medicare options?

A licensed Lehigh Partners Senior Benefits agent can help you review Medicare Supplement, Medicare Advantage, and Part D options based on your doctors, prescriptions, pharmacy, budget, and coverage preferences.

Schedule a Medicare Review Call 833-265-9655

No pressure. No obligation. Just clear Medicare guidance.