You can find a Medicare Part D plan finder tool on the Medicare website, but before you check it out, you’ll need to know what to look for in a prescription drug plan.
Unlike Medicare Part A and Part B, which are administered by the federal government, Part D plans are offered by private insurance companies. There are many differences between each company’s Medicare Part D plans.
What Does Medicare Part D Cover?
Before 2006, there was no meaningful prescription drug coverage under Medicare. Part D was created in the Medicare Modernization Act of 2003 to help offset the cost of prescription drugs.
Part D was created in the Medicare Modernization Act of 2003 to help offset the cost of prescription drugs.
CMS establishes a baseline level of prescription drug coverage for all Part D plans approved by Medicare. Plans must cover all commercially available vaccines and all drugs in the “protected” classes which include medications such as antidepressants and anticonvulsants, as well as medications that prevent transplant rejection.
Beyond that, insurers can decide which drugs they will cover and how much they will pay for each medication. Part D plans generally cover a wide range of drugs to treat most illnesses and diseases.
Understanding Your Part D Formulary
Every Medicare Part D plan uses a drug list called a formulary, which includes all of the medications the plan covers and the amount you have to pay for each.
Most Part D plans use a tiered formulary; you pay less for drugs in the lower tiers and more out-of-pocket for drugs in the upper tiers. Generic medications are usually in Tier 1 and have copays ranging from $0 to $10 in most plans.
For example, you may have to get prior authorization before your plan pays for a particular drug.
Sometimes, plans put special conditions on certain drugs in their formulary. For example, you may have to get prior authorization before your plan pays for a particular drug. Your plan may require that you try a less expensive drug to see if it works before it will pay for a more expensive one.
It’s not uncommon for plans to place quantity limits on certain medications, which limit the number of doses you can get at one time or during a particular period of time.