Step 1
Gather what you need
Have your Medicare card, ZIP code, current medication list, and preferred pharmacies ready. This helps you compare which plans cover your prescriptions and what your costs may be.
- Independent Agency
- Multiple Carriers
- Licensed Advisors
- Ongoing Support
Part D basics
What is Medicare Part D, and what is it used for?
Medicare Part D is prescription drug coverage offered by Medicare-approved private insurance plans. It helps pay for many outpatient prescription drugs. Part D also covers adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) at no out-of-pocket cost. Part D can be a stand-alone drug plan with Original Medicare or included in a Medicare Advantage plan.
Each plan has its own list of covered drugs (called a formulary), pharmacy network, premiums, and cost sharing. Part B covers a limited number of outpatient prescription drugs under certain conditions; Part D generally covers many drugs Part B does not.
How to apply
How do I get Part D coverage?
You must join a Medicare-approved plan that offers drug coverage. You can get Part D through a stand-alone Medicare drug plan or through a Medicare Advantage plan that includes drug coverage.
Step 2
Review your options
Compare each plan’s drug list, pharmacy network, premium, deductible, and cost sharing. If you already have Medicare Advantage, check with your plan before joining a separate drug plan because it could change your health coverage.
Step 3
Choose a plan and enroll
You can enroll during your Initial Enrollment Period, the yearly Open Enrollment Period (October 15–December 7), or a Special Enrollment Period if you qualify. A Special Enrollment Period may be available if you involuntarily lose creditable drug coverage or your current coverage changes and is no longer creditable.
The Assurance Network can review Part D options with you and help you complete an enrollment application.
How Part D fits with your Medicare coverage
Part D works differently with Original Medicare and Medicare Advantage
A stand-alone Part D plan is usually added to Original Medicare. Most Medicare Advantage plans include Part D as part of the health plan, so you generally do not add a separate drug plan.
Original Medicare and Medigap
If you have Original Medicare, you can add a separate Part D Prescription Drug Plan. You may also have a Medicare Supplement Insurance (Medigap) policy to help pay some costs under Original Medicare.
Medigap is separate from Part D. Medigap policies sold after 2005 do not include prescription drug coverage, so you need a separate Part D plan if you want that coverage. Some older Medigap policies may include drug coverage; check with your insurer before making a change.
Medicare Advantage
Most Medicare Advantage plans include Part D. In most cases, you cannot be enrolled in a separate Part D plan while enrolled in a Medicare Advantage plan. If you join a separate drug plan while in an HMO or PPO, you’ll generally be disenrolled from that Medicare Advantage plan and returned to Original Medicare.
Limited exceptions allow separate drug coverage with certain plans, including a Private Fee-for-Service plan without drug coverage, a Medical Savings Account plan, a Medicare Cost Plan, or certain employer or former-employer plans. Check with your current plan before enrolling in a separate Part D plan.
2027 Part D costs
What could I pay for Part D?
Your monthly premium and out-of-pocket costs depend on the plan and the medicines you take. Compare the plan’s total costs for your own prescriptions, not just its monthly premium.
Deductible
Up to $700 in 2027
For 2027, no Medicare drug plan can have a deductible higher than $700. Some plans have no deductible.
Annual out-of-pocket limit
$2,400 in 2027
For covered Part D drugs, once your qualifying out-of-pocket costs reach $2,400 in 2027, you enter catastrophic coverage and pay $0 for covered Part D drugs for the rest of that calendar year.
Avoiding a late penalty
When can the Part D late enrollment penalty apply?
You may owe a Part D late enrollment penalty if, after your Part D Initial Enrollment Period ends, you go 63 or more days in a row without Medicare drug coverage or other creditable prescription drug coverage, then enroll in Part D later.
Not having Part D alone does not automatically mean you owe a penalty. If you have other drug coverage that Medicare considers creditable, you generally can delay Part D without a late penalty while that coverage continues. Ask the employer, union, or plan providing your coverage whether it is creditable and keep its annual notice.
- Some employer or union plans may provide creditable drug coverage.
- VA and TRICARE drug coverage are examples of coverage that may be creditable.
- Keep your creditable-coverage notices in case a future Part D plan asks about your coverage history.
- People who qualify for Extra Help do not pay the Part D late enrollment penalty.
How the penalty is calculated
The penalty is generally 1% of the national base beneficiary premium for each full month you were eligible for Part D but did not have Part D or creditable drug coverage.
2027 base: $41.33
Example: 14 uncovered months × 1% × $41.33 = $5.7862, rounded to $5.80 per month for 2027.
The amount is added to your Part D premium. The base amount can change each year, so the penalty may change too. In general, you pay the penalty for as long as you have Medicare drug coverage, even if you switch plans.
Starting Medicare at 65
Your 7-month window to enroll in Parts A and B
If you’re eligible for Medicare when you turn 65, your Initial Enrollment Period lasts 7 months: it begins 3 months before the month you turn 65, includes your birthday month, and ends 3 months after.
3 monthsbefore the month you turn 65
Your birthdaythe month you turn 65
3 monthsafter the month you turn 65
Medicare enrollment timing
The Part B late enrollment penalty
Part B has a separate late enrollment penalty. The Part D penalty is explained above.
Part B (medical insurance)
Your monthly Part B premium may increase by 10% for each full 12-month period you could have had Part B but didn’t. You generally pay this penalty for as long as you have Part B. You generally won’t owe it if you qualify for a Special Enrollment Period or enroll in a Medicare Savings Program.
A quick reminder
Before you delay or drop Part D
Confirm that any other prescription drug coverage is creditable and find out when it will end. If you expect a coverage change, review your Part D enrollment timing so you can avoid an uncovered period that may lead to a penalty.
Part D plan availability, covered medications, pharmacies, premiums, and cost sharing vary by plan and location. Review the plan’s current information before enrolling.
From Medicare.gov: Read Medicare’s Part D coverage choices · Read about Part D costs and penalties · Learn about creditable drug coverage
Medicare enrollment requirement
You must be enrolled in Medicare to get Part D
To join a stand-alone Medicare prescription drug plan, you must have Medicare Part A, Part B, or both. You do not need both parts for a stand-alone Part D plan. If you choose a Medicare Advantage plan with drug coverage, you must have both Part A and Part B.
Option 1
Stand-alone Part D plan
A stand-alone Prescription Drug Plan (PDP) adds Medicare drug coverage to Original Medicare and certain other eligible Medicare plan arrangements.
- You must have Medicare Part A or Part B. You do not need both just to join a stand-alone Part D drug plan.
- You must live in the plan’s service area.
- You must meet Medicare’s citizenship or lawful-presence requirements.
Option 2
Drug coverage in a Medicare health plan
Some Medicare health plans include Part D drug coverage as part of the plan. To join a Medicare Advantage plan with drug coverage, you must have both Medicare Part A and Part B and live in the plan’s service area.
Check whether the plan includes prescription drug coverage before enrolling. Joining a separate drug plan can affect enrollment in some Medicare health plans.
Questions about Part D?
The Assurance Network can provide straightforward guidance as you review Medicare prescription drug coverage options.
Information on this page is educational and is not a complete description of every Medicare Part D rule or plan. Eligibility, benefits, costs, and enrollment opportunities depend on your circumstances and plan availability. Verify your coverage details with the plan and Medicare. The 2027 Part D penalty example uses CMS’s 2027 national base beneficiary premium of $41.33. Not affiliated with or endorsed by the federal government or the federal Medicare program.