Prescription Drug Coverage with Medicare Part D in Oregon and Washington
Original Medicare does not cover most prescription drugs. That’s why many turn to Medicare Part D for help covering the cost of medications.
Medicare Part D plans are optional but important. Even if you don’t take many medications now, skipping Part D when you're first eligible can lead to late enrollment penalties down the road. In this guide, we’ll explain how Part D works, what it costs, and how to choose the right plan for your needs.
What Medicare Part D Covers and Why It Matters
What Is Medicare Part D?
Part D is Medicare’s outpatient prescription drug coverage, offered through private insurance companies. Each plan has its own drug list (formulary), costs, and pharmacy network. You can choose a stand-alone Part D plan if you have Original Medicare or a Medigap plan, or you may get drug coverage through a Medicare Advantage plan.
How Drug Costs Are Structured
Part D plans generally include:
- A monthly premium (varies by plan)
- An annual deductible (some plans waive this)
- Copays or coinsurance for prescriptions
- An out-of-pocket maximum (the most you will pay in a year)
We will help you estimate your yearly drug costs so you’re not surprised at the pharmacy counter.
Why Enrollment Timing Matters
If you don’t enroll in a Part D plan when you're first eligible and you don’t have other credible drug coverage, you could face a permanent late enrollment penalty. That’s why even if you take few or no medications, it’s smart to enroll in a low-cost plan to avoid penalties.
You can only join or switch Part D plans during the
Annual Enrollment Period (October 15 to December 7), unless you qualify for a Special Enrollment Period.
How to Choose a Part D Plan That Works for You
We help our clients choose Part D plans based on their personal medication list. Here's what we consider:
- Which drugs you take (generic vs. brand)
- What pharmacy you use
- What plan tiers your drugs fall under
Each plan covers drugs differently. We use special software with our local carrier knowledge to help find the best fit for you. Our one-on-one reviews can make the process a lot easier.
What You Should Know About Medicare Drug Plans
What drugs are covered under Part D?
Each plan has a formulary—a list of covered drugs. Medications are grouped into tiers that affect how much you pay.
Can I skip Part D if I don’t take any prescriptions?
You can, but you’ll face a penalty if you enroll later. We often recommend a low-cost plan to avoid this.
How do I get Medicare Part D?
Enroll when you're first eligible, or during the Annual Enrollment Period. We can walk you through the steps and compare options.
If I have a Medicare Advantage plan, do I still need Part D?
Most Medicare Advantage plans already include drug coverage. If you have an MA-PD, you don’t need a separate Part D plan.
What if I have a Medicare Supplement plan?
You may need to enroll in a stand-alone Part D plan to cover prescriptions. Medigap plans don’t include drug benefits.
Source Attribution:
This information was obtained from www.medicare.gov.