Original Medicare is a government-sponsored insurance program designed to help people over age 65 meet their health care needs. It covers doctor care and hospital visits, but it does not include the cost of pharmaceuticals. For that, policyholders need to purchase the optional Medicare Part D prescription plan coverage. If you are unfamiliar with Part D coverage, below is an introduction.

What Is Medicare Part D Prescription Plan Coverage?

What Drugs Are Covered?

Original Medicare only covers portions of drugs administered as part of a doctor or hospital visit, such as antibiotic infusions or chemotherapy. Part D plans cover some or all of the cost of other prescription drugs. All plans must offer two types of each drug as well as diabetes supplies and vaccines. They must also cover most or all of the following types or pharmaceuticals: antidepressants, anticonvulsants, antipsychotics, immunosuppressants, cancer drugs, and HIV/AIDS drugs.

How Do You Qualify?

To qualify for Medicare Part D, you must already have Original Medicare (Parts A and B) or Medicare Advantage (which provides HMO or PPO coverage). You must also live in—or move to—an area covered by a Part D plan provider. Lastly, you may be disqualified if you suffer from end-stage renal disease. If you qualify, work with one or more agents to find the right plan that meshes well with any other coverage you have, including employer-sponsored plans, VA benefits, COBRA or Federal Employee Health Benefits.

What Are Drug Tiers?

Many plans organize prescription drugs into tiers, by which they determine how much policyholders must contribute for each prescription. Tier 1 drugs are typically generic and very common and cost patients the least. Tier 2 drugs are preferred brand-name products—not generic, but not expensive—for which you may have to contribute a larger copayment. Tier 3 are non-preferred name-brand drugs that cost more than Tier 1 and Tier 2 products. Finally, Tier 4 contains unique or expensive products for which you will contribute the most.

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