Compare Medicare Advantage plans and quote side-by-side to get the best rate here.

Many new Medicare enrollees are surprised to learn that Original Medicare coverage does not extend to prescription drugs taken outside of a hospital setting. If you take a variety of prescription drugs, this factor can mean that you might end up paying significantly more for your healthcare needs after retirement when compared to the private insurance plan you had while you were working. Thankfully, you don’t need to pay for your medication costs out of pocket with a Part D plan.

Medicare Part D is an optional add-on policy that helps you cover the costs of your prescription drugs. This Medicare Part D 2021 guide will help you learn more about your prescription drug coverage options and a few of Benzinga’s favorite providers.

What Is Medicare Part D?

Medicare Part D coverage (sometimes referred to as “Medicare prescription drug coverage”) is a type of add-on insurance that helps you pay for the cost of routine prescription medication. To purchase a Part D plan, you must be a Medicare policyholder who is currently enrolled in Original Medicare.

The Best Companies for Medicare Part D Plans

Compare Plans securely through CoverRight’s website
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1 Minute Review

CoverRight simplifies this process of finding the right Medicare or Medicare Supplement plan, also known as Medigap. They’re a consumer-first platform helping Medicare-eligible people pick the best plans.

After completing a simple online form or phone call, a dedicated agent will prepare personalized quotes that make sense for you, whether it’s a Medigap policy or a Medicare Advantage plan. CoverRight’s agents can help you determine which plan makes the most sense for your budget and health care needs. 

CoverRight has extensive customer service hours. It provides independent advice, and working with CoverRight is free. 

Best For
  • Medicare-eligible people
  • People who want assistance choosing the right plans
Pros
  • Easy application process
  • Assistance in finding the right insurance plan
  • Help in finding an insurance plan that covers your doctors and medications
  • Concierge-style service with your own dedicated agent
Cons
  • Not available in every state
get started Call Now securely through Aetna Inc’s website
Best For
Easy access to benefits and member support
N/A
1 Minute Review

Shop for Medicare Advantage and Supplement plans and more with Aetna. Benefit from a wide provider network and easy access to your benefits as well as hefty membership perks.

Best For
  • Easy access to benefits and member support
Pros
  • Preventative care planner
  • Easy access to tools and resources
  • Wide network access
Cons
  • Need a referral for certain procedures and specialists
get started Call Now securely through Cigna’s website
Best For
Easy access to benefits
N/A
1 Minute Review

Easily shop and compare Medicare Advantage Plans, Part D Prescription Plans and Medicare Supplement Insurance. Cigna provides end-to-end assistance and provides plenty of member benefits at no extra cost.

Best For
  • Easy access to benefits
Pros
  • Home delivery for prescriptions
  • Health management mobile apps
  • Easy ID card replacement
Cons
  • Can have high deductibles
Best For
Medicare Advantage Plans
N/A
1 Minute Review

Humana is a trusted provider of Medicare Advantage and Medicare Supplement plans alike. Save both time and money by shopping online — get a 6% discount if you enroll online.*

*Offer not available to California, Connecticut and Ohio residents.

Best For
  • Medicare Advantage Plans
Pros
  • Medicare Parts A + B and Medigap plans available
  • 6% discount if you enroll online
  • Shop plans by ZIP code
Cons
  • Discount not available CA, CT and OH
get started securely through Mutual of Omaha’s website

Medicare Part D Eligibility

If you qualify for Medicare and you are already enrolled in Medicare Part A and Medicare Part B, you are eligible to purchase a Medicare Part D 2021 plan. These plans are sold through private providers, and premiums and copays vary between plans. Waiting to enroll in Part D coverage may result in a premium penalty.  

What Does Medicare Part D Cover?

Medicare Part D covers prescription drugs. However, not every drug is treated equally by your Medicare Part D plan in terms of coinsurance and copays. Plan D providers divide medications into 4 tiers depending on the price of the drug.

  • Tier 1: Tier 1 includes most generic prescription drugs. Prescriptions in the first tier usually come with low or no copays on most Part D plans — if you do have a copay, prescriptions on this tier will be lower than other tiers.
  • Tier 2: Tier 2 includes preferred brand-name drugs. You will have a medium copay on your Part D plan if you need to fill a prescription in this tier.
  • Tier 3: Tier 3 includes non-preferred, brand-name prescription drugs. In many cases, your insurance company will require you to try the generic version of drugs on this tier before they’ll approve Tier 3 prescriptions. You’ll pay a higher copay for drugs on this tier.
  • Specialty Tier or Tier 4: This tier contains drugs that have very high costs. You’ll pay a higher copay for this tier, and you may also need to pay a coinsurance percentage.

Each individual Part D plan provider can choose which drugs are in which tier on its plan. If your doctor believes that you need a higher-tier drug that is not substitutable for a generic version, you and your healthcare provider may need to petition your Part D provider to receive a lower copay or coinsurance percentage. 

What Drugs Are Covered by Medicare Part D?

When you sign up for a Medicare Advantage or a Medicare Part D plan, your plan provider will provide you with a document called a “formulary” that lists which drugs are included in coverage. While Medicare plan providers are required to offer at least 2 drugs in the most commonly prescribed categories and classes, plan providers do not need to cover every drug in each category.

Medicare Part D formularies can vary widely between plan providers, and each insurance company may choose its own formulary composition. If you’re already taking a specific prescription medication, be sure to check your plan’s formulary to ensure that your drugs are covered before you sign onto a plan.

There are also protected classes under Medicare prescription drug plans that require your insurance provider to offer coverage for almost all drugs in the following classes:

  • Antidepressants
  • Antipsychotics
  • Anticonvulsants
  • Immunosuppressants
  • Drugs used to treat cancer
  • Drugs used to treat HIV/AIDS

Your Part D plan provider may change its formulary during the year as long as the changes fall under Medicare’s regulations. If your plan provider does change its formulary to exclude or change the copayments on a drug that you’re currently taking, they must provide you with 1 of the following:

  • Written notice at least 30 days before the change goes into effect
  • Written notice of the change at the time that you request a refill, as well as a month’s supply of the prescription under the previous costs and rules

Plan D providers may also immediately remove drugs from their formularies if the U.S. Food and Drug Administration (FDA) deems them to be unsafe or if the manufacturer of the drug recommends that they be removed voluntarily. Some Medicare Part D providers may also be authorized to remove brand-name drugs from your formulary if a new generic drug is introduced to the market.

Medicare Part D Plans Full Overview

Medicare Part D, sometimes called prescription drug coverage, is an add-on that you can purchase that offers coverage for self-administered prescription drugs. Medicare Part D is optional and not included with original Medicare. Medicare Part D can help you cover the costs of any prescription drugs you take outside of the hospital. Professionally-administered prescription drugs are almost always covered under Medicare Part A or B.

Do you have a Medicare Advantage plan? It might mean you already have prescription drug coverage. Most Advantage plans include benefits similar to those you get with Part D coverage as well as other protections. A Medicare supplemental insurance policy means you may purchase Part D coverage only if your Medigap policy does not offer drug benefits.

Though Part D plans are optional, you are fully liable for the financial costs of your prescription drugs if you have Original Medicare and don’t buy a plan. Part D plans are affordable in most states, so most people who are on Medicare Parts A and B also choose to get Part D coverage as well. 

Part D plans work the same way as most non-Medicare health insurance plans. Each month, you pay your plan provider a monthly premium. In exchange, your plan provider pays for a percentage of your drug costs each month. There are 4 stages of payment you’ll go through when you sign up for a Part D plan:

  • Annual deductible. Your deductible is the amount of money you need to pay toward your prescriptions before your insurance kicks in and begins paying for your drugs. In 2019, a Medicare Part D provider cannot charge you more than $415 in an annual deductible.
  • Initial coverage. After you hit your deductible, your provider will begin to cover a percentage of your drug costs laid out in your plan agreement. Copays can vary by plan type, drug tier and provider. You will stay in this stage until you and your insurance company together spend $3,820 in total. $3,820 is the limit for 2019 — and this number may change in later years.
  • Coverage gap. Once you and your insurance provider spend up to the initial coverage limit, you reach the coverage gap stage. During this stage, you pay a higher percentage of your drug costs. Once you spend $5,100 out of pocket (2019’s coverage gap limit) you enter the catastrophic coverage stage.
  • Catastrophic coverage. Once you reach this stage, you begin paying a different copay for every generic and brand name drug you take. Copays during the catastrophic stage are much lower than the initial coverage stage. 

You can only get a Part D plan if you already have Original Medicare. To qualify for Medicare, you must:

  • Be 65 years old or older
  • Be a younger person with a qualifying disability
  • Have end-stage renal disease (permanent kidney failure requiring dialysis or transplant)

Not sure you qualify? Use Medicare.gov’s eligibility tool

Medicare Part D Plans Laws

Medicare Part D plans are legal in every state and are available for everyone with a Medicare plan. Unlike Medicare Part A and B, Medicare Part D plans aren’t administered by the federal government. Instead, they’re offered by private insurance providers who have Medicare approval. Not every Medicare Part D plan provider has authorization in every state. Take the time to research providers who service your area before you enroll.  

Medicare rules allow Part D plan providers to apply certain restrictions on drug usage. These restrictions are for both safety and cost containment. Some rules you might run into include:

  • Prior authorization. Part D plan providers only want to pay for drugs that are medically necessary. If you or your doctor receive a prior authorization request, it means that your pharmacy cannot dispense your prescription until your doctor confirms that the specific drug is necessary for your treatment. Prior authorization requests are common for highly potent and very expensive brand-name drugs.
  • Quarterly limits. Quarterly limits restrict how much medication you can get on each of your drug refills. Each individual drug has its own quarterly limit. If your doctor prescribes more than your drug’s quarterly limit, your doctor may need to write an explanation to the insurance company explaining why you need this much of your medication.
  • Step therapy. Step therapy involves trying generic versions of drugs 1st to test the ingredients’ effectiveness before moving onto brand-name drugs. Your doctor will have to file an exception request with your insurance provider if he or she believes that taking a generic version of a drug is dangerous or ineffective for your treatment schedule. 

Not every prescription is covered under every Part D plan. There are no rules that dictate which drugs the provider must choose, though each Part D plan provider must offer coverage for at least 2 drug options in every major disease category. Before you sign onto a plan, check the plan’s formulary and make sure your prescriptions are covered. 

Compare Medicare Part D Plans

Medicare Part D plan options vary from company to company, and each insurance provider can choose which specific drugs are included in its formularies for each category. When comparing plans, you’ll want to consider:

  • Premium price and how it fits into your monthly budget
  • Copays for frequently needed medications
  • The medications that you’re currently taking and how they fit in each plan’s formulary
  • Your location and the insurance providers authorized to provide plans in your area

If you aren’t sure where to begin your search for your best option for Medicare Part D 2021 coverage, consider a few of Benzinga’s top providers below. 

Medicare Part D Insurance Provider Reviews

Now that you understand how Part D plans work, let’s take a look at some of the best Part D options on the market.  

Best For
Getting help picking the right Medicare plan
Pros
  • Highly rated on independent review site Trustpilot
  • Allows you to speak with a live representative
  • Extended customer service options
Cons
  • Does not offer any individual Medicare Supplemental coverage options itself

1. easyMedicare: Best Overall

easyMedicare believes finding your Medicare plan should be, well… easy. Its licensed sales agents can personally guide you through available the plan options, discuss your healthcare insurance needs and confidently choose a plan that fits you.

Its agents are Medicare insurance advisors 1st. You’ll be guided every step of the way as you shop many of Medicare’s respected health insurance carriers including Humana, UnitedHealthcare, Cigna-HealthSpring, Aetna and Wellcare.

Best For
Member support
Pros
  • Offers multiple mobile app offerings to reward you for reaching fitness goals
  • Dental discount plans may include coverage for prescription drugs
  • Medicare Advantage plans available with no monthly premiums
Cons
  • Vision insurance only available when purchased with a dental plan
  • ACA-compliant health insurance no longer available

2. Aetna: Cheapest Medicare Part D Plan

If you’re on a limited income and you’re concerned about deductibles and copays, Aetna might be the right Plan D provider for you. Aetna offers 3 tiers of Part D plans, and plans are available with $0 deductibles so you start saving right away.

Aetna’s most affordable plan, Aetna Medicare Rx Select, has an average monthly deductible of just $17. The Rx Select plan also features a $0 deductible for all Tier 1 and 2 drugs, which encompass most generic prescriptions. And Aetna provide assistance if you receive income supplement support. 

Best For
Medicare Advantage Plans
Pros
  • Medicare Parts A + B and Medigap plans available
  • 6% discount if you enroll online
  • Shop plans by ZIP code
Cons
  • Discount not available CA, CT and OH

3. Humana: Best Coverage for Medicare Part D Plan

The availability of Part D plans can vary depending on where you live. If you’re concerned about getting a plan near you, consider Humana.

Humana has a wide coverage network in most states, and you can even schedule 30-day prescription deliveries to your door. This is useful if you live in 2 different states throughout the year and you don’t want to worry about running over your quarterly limits while you’re out of your home state.

If you don’t currently take any prescription medications but you still want to maintain Part D coverage just in case, Humana might be the best Medicare Part D 2021 option for you. Humana offers affordable value plans that cover more than 3,500 prescription drugs for less than $20 a month. You’ll also enjoy even more benefits with preferred cost sharing when you shop at participating Humana-approved pharmacies. 

Humana Part D plans are accepted at many national chains including Sam’s Club, Walmart and Walgreens. 

Best For
Retired seniors older than 50
Pros
  • Multiple lines of coverage available
  • Policy perks like discounts for entertainment and travel
  • Low membership fees, which include membership for a spouse
Cons
  • Members may receive unsolicited advertising materials
  • Health insurance may not be the least expensive, especially for seniors in good health

4. AARP Walgreens Rx Plan: Best for Comprehensive Drug Inclusions

The American Association of Retired Persons (AARP) has partnered with Walgreens to formulate an easy, low-cost and convenient plan for Part D holders.

The AARP MedicareRx Walgreens Plan has a comprehensive list of included drugs and an easy-to-use search feature that allows you to quickly see whether your prescriptions are covered. The plan is available even if you aren’t an AARP member, and most plans include $0 deductibles.

You’ll need to pick up your prescription from a Walgreens to take advantage of this offer but there are over 9,500 Walgreens stores in the U.S. — chances are, you’re close to 1. 

Best For
Medicare Prescription Drug Plans
Pros
  • The Flex card adds extra benefits for added savings
  • No co-pay for certain Tier 1 drugs with PDP plans
  • Dividend payments refund Medicare Part B premiums for certain members in select markets
  • Medicare Advantage plan offers free prescriptions for retired veterans
Cons
  • Mixed customer service reviews

5. WellCare: Best for Customer Service

Cigna, Aetna and Humana don’t only offer Part D plans — they also focus on other types of insurance.

This can make it more difficult to connect with experts on Medicare plans. On the other hand, WellCare only offers Medicare plans. This means that its customer service team members are all well-versed in Medicare Part D and can be more effective in helping you find the right solution for you.

WellCare also offers plans in most states and many choices also have $0 deductibles. Are you the type of person who values top-quality customer service above all else? Consider a WellCare plan. 

Best For
Easy access to benefits
Pros
  • Home delivery for prescriptions
  • Health management mobile apps
  • Easy ID card replacement
Cons
  • Can have high deductibles

6. Cigna: Best for Low Copays

If you need frequent medication refills, it can be helpful to choose a plan that offers affordable copays. Cigna offers generous copays for its Tier 1 drugs.

Most plans come with $0 copays for 90-day supplies of Tier 1 generic drugs, and higher tier drugs may also come with copays as low as $4 depending on your plan option.   

Compare quotes for Medicare Part D plans from Cigna and other providers here.

Best For
Same day coverage available
Pros
  • Offers a wide variety of plans
  • Strong financial and customer service ratings
  • ACA and non ACA plans available
Cons
  • Not all plans ACA-compliant
  • The website can make it difficult to get a quote

7. Best for Low Deductible Options: UnitedHealthcare

With many plans, you’ll need to meet a deductible before you can use your coverage to pay for the costs of your medication. UnitedHealthcare offers a range of plan options that you can use to reduce your deductible and start using your coverage sooner.

For example, the company’s MedicareRx Walgreens plan comes with $0 copays and deductibles on Tier 1 and 2 drugs, while other plans have $0 deductibles on all classes of drugs. 

8. Best for Wide Availability: SilverScript

Not every health insurance provider is licensed to offer Part D plans in every state, which can make choosing a plan more difficult if you’re thinking about moving soon after enrolling in Medicare.

SilverScript offers Part D plans in all 50 states, which means that you’ll likely be able to take your coverage when you move. SilverScript also offers in-home prescription delivery when you fill your drug orders through CVS.  

9. Best for Comparing Plans: HealthInsurance.com

If you’re running out of time to get Part D coverage, one of your 1st stops when searching for a plan should be HealthInsurance.com. HealthInsurance.com is an all-inclusive search tool that you can use to instantly view a list of plan options in your area.

Enter your zip code and any medications you’re currently taking, and HealthInsurance.com will gather quotes on your behalf. This feature can speed up the process of choosing a Part D coverage option. 

Get Medicare Part D and Get Prescription Drug Coverage Early

Even if you aren’t currently taking any prescription drugs, you should still begin comparing options for Medicare Part D 2021 coverage. You never know when you might need to begin a medication — and you may not be able to enroll in coverage if you miss Medicare’s Open Enrollment period. Be sure to compare your options and get a quote from a few of Benzinga’s recommended providers so you know all your options when you sign up for Medicare coverage. 

Frequently Asked Questions

Q

What are the different parts of Medicare?

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What are the different parts of Medicare?
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Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.

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Q

Is Medicare free?

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Is Medicare free?
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Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.

Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.

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Q

Do I need to sign up for Medicare?

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Do I need to sign up for Medicare?
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If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers. 

If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.

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Q

What is the deductible for Medicare Part D?

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What is the deductible for Medicare Part D?
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Deductibles vary between Medicare drug plans. However, no plan provider can charge a deductible higher than $445 in 2021

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Q

What is the cost of Medicare Part D for 2021?

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What is the cost of Medicare Part D for 2021?
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Medicare Part D premiums vary by insurance company, and each company sets its own monthly premium for each plan it offers. Comparing multiple Medicare Part D plan choices can help ensure you get affordable coverage. 

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