Understanding Medicare Part D

What is Medicare Part D?
Medicare Part D covers a wide range of prescription drug costs that aren’t covered by Original Medicare (Part A and Part B). It also provides coverage for some vaccines, like shingles.

You can enroll in Part D once you’re eligible for Medicare Part A or enrolled in Part B. You can pair a stand-alone Part D plan with Original Medicare or choose a Medicare Advantage plan that includes Part D coverage.

What are the phases of a Medicare prescription drug plan?

Phase 1

Deductible period: When you start using your prescription drug coverage, you’ll first need to meet your plan’s annual prescription deductible, if there is one.

Phase 2

Initial coverage period: Then, you’ll pay a copay or coinsurance for each prescription until you and your plan’s spending on prescriptions reaches the initial coverage limit.

Phase 3

Coverage gap: After the initial coverage limit is met, you enter the coverage gap, also known as the donut hole. You’ll pay 25% of your plan’s negotiated price for generic and brand-name drugs until your spending on prescription drugs reaches the total out-of-pocket threshold.

Phase 4

Catastrophic coverage: Once the out-of-pocket threshold is met, you enter catastrophic coverage, and you’ll only pay a small amount for your covered drugs for the rest of the year. Your plan pays the rest.

Is there a penalty if I don’t enroll in Part D?

If you don’t choose a Medicare Part D plan when you’re eligible, and don’t have other creditable drug coverage, there will be a permanent penalty added to your Part D premium for every month you could have enrolled but didn’t. So it may pay to enroll even if you don’t use prescription drugs now.

What are some tips to save money on Medicare Part D?

• Check the plan’s pharmacy network for preferred pharmacies
• Take advantage of mail delivery options
• Choose generic drugs over brand name
• Research your medications, since some drugs require prior authorization or have quantity limits

What is the Medication Therapy Management program?

Taking multiple medications can increase the risk of drug interactions, side effects and other complications. Through the Medication Therapy Management (MTM) program, you can get one-on-one guidance from a pharmacist or other trained health care provider. They’ll make sure your medications are safe and working for you—and may help you find lower-cost options.

Ready to enroll in a Medicare Part D plan?

Our Regence Medicare plan advisors can help guide you. Call 1-844-REGENCE (1-844-734-3623) (TTY:711), 9 a.m. to 5 p.m., Monday through Friday.

Last updated 10/01/2023
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