Is Medicare Part D right for you?

Older man holding medicine container

If you’re age 65 or older and need help paying for prescription drugs, Medicare Part D may be right for you. Part D, also known as the Medicare prescription drug plan, helps cover a portion of the cost of outpatient prescription drugs for Medicare participants. Here’s what you need to know to determine if Medicare Part D is right for you.

Types of Medicare

To decide whether Part D is right for you, first you’ll need to know the Medicare coverage basics. Medicare Part A is provided to many people at no cost at age 65, once you enroll. Part B, which has an annual premium that you have to pay, is optional coverage that pays for services Part A doesn’t cover. Part A and Part B is considered Original Medicare. If you’re only enrolled in Medicare Part A or Part B, you may be eligible for Part D.

Medicare Part C is an optional, premium-based coverage for services that neither Parts A or B cover. You must be enrolled in Parts A and B to be eligible for Part C.

While Medicare Part D is optional, it offers coverage for prescription drugs that may not be covered under Parts A, B or C. Based on your situation, it may be worth purchasing.

How Medicare Part D works

Before enrolling in Part D, you must first be enrolled in Medicare Parts A and/or B or in Part C. To enroll in Part D, you must choose from plans run by an insurance company or other private company approved by Medicare.  

After enrollment, you’ll pay a monthly fee that varies by plan. Each plan will have its own deductible, coverage copay and coinsurance amount for each prescription drug type. The Part D copay chart below offers a general idea of how Medicare breaks down its prescription drug tiers. Drugs in each tier have a different cost.

Part D copay tiers

Tier 1 ($)

Generic

Tier 2 ($$)

Preferred

Tier 3 ($$$)

Non-Preferred

Tier 4 ($$$$)

Specialty

  • Lowest copayment
  • Most generic drugs covered
  • Medium copayment
  • Preferred brand-name prescription drugs covered
  • Higher copayment
  • Non-preferred, brand-name prescription drugs covered
  • Highest copayment:
  • Very high-cost prescription drugs covered

Some prescription drugs are excluded from coverage with Part D, so be sure to confirm coverage for any prescription drug you currently take, prior to choosing a plan.

Consider all your choices

Before you purchase coverage, learn how Medicare Part D will interact with any other coverage you may already have, such as coverage through your employer, TRICARE, and Medigap policies. The drug coverage you currently have, if any, may change as a result of your enrollment in Part D.

To learn more about Medicare Part D or if you’re ready to purchase, visit the Medicare Plan Finder to search by zip code for available options near you.

The advice provided is for informational purposes only. For additional guidance on Medicare, contact your local Social Security office or Seniors’ Health Insurance Information Program (SHIIP) with the N.C. Department of Insurance.

Share this article: