PDP Prescription Drug Plans

Purpose

Medicare does not include prescription drug coverage in Original Medicare (Parts A and B). To help with medication costs, you can enroll in a PDP, which provides prescription drug benefits.

Eligibility

Anyone who is eligible for Medicare can enroll in a PDP. This includes people who are enrolled in Medicare Part A and/or Part B. If you have a Medicare Advantage plan (Part C), some of these plans include prescription drug coverage, so you wouldn’t need a separate PDP.

Coverage

PDPs help cover the cost of a wide range of prescription medications. Each plan has its own formulary, which is a list of covered drugs. The formulary may include different tiers, with varying costs for each tier. Some plans may also have coverage limits on certain medications.

Costs

Enrolling in a PDP usually involves a monthly premium, which is in addition to the premiums you pay for Medicare Part B. You might also have to pay a portion of the cost for your prescriptions, such as copayments or coinsurance. PDPs often have a deductible, which is the amount you must pay out-of-pocket before the plan starts to pay for prescriptions. The deductible and out-of-pocket costs vary by plan.

Enrollment Periods

You can sign up for a PDP during the Initial Enrollment Period, which starts three months before you turn 65 and ends three months after your birthday month. You can also enroll or make changes to your PDP during the Annual Enrollment Period (October 15 to December 7 each year). If you miss these periods, you may have to wait until the next Open Enrollment Period or qualify for a Special Enrollment Period based on specific circumstances.

Choosing a Plan

When selecting a PDP, it’s important to review the plan’s formulary to ensure it covers your medications. Compare different plans based on their premiums, coverage, and out-of-pocket costs. Some plans may offer extra benefits like lower costs for certain drugs or additional coverage options.