What Is Medicare Part D? Understanding Prescription Drug Coverage

Medicare can be confusing—especially when it comes to prescription drug coverage. That’s where Medicare Part D comes in.

At Temecula Medical Group, we want to help you understand your options so you can get the medications you need without surprises. In this post, we’re breaking down Medicare Part D, what it covers, and how it works with your overall care.

What Is Medicare Part D?

Medicare Part D helps cover the cost of prescription drugs. It’s offered by private insurance companies that are approved by Medicare, and you can get it in one of two ways:

1. As a stand-alone prescription drug plan (PDP) — used with Original Medicare

2. As part of a Medicare Advantage plan (Part C) that includes drug coverage

You are not automatically enrolled in Part D—you must sign up for it separately if you need it.

What Does Medicare Part D Cover?

Each Part D plan has its own formulary—a list of covered medications. The formulary is organized into tiers, with lower-tier drugs (like generics) costing less than higher-tier brand-name or specialty medications.

Most Part D plans cover:

• Generic and brand-name drugs

• Common maintenance medications (for conditions like high blood pressure, diabetes, or high cholesterol)

• Vaccines like shingles and Tdap (flu and COVID-19 vaccines are covered under Part B)

Tip from Temecula Medical Group: Always review your plan’s formulary to make sure your medications are covered—and ask our team if you need help.

What You’ll Pay

Your costs under Medicare Part D may include:

• A monthly premium (varies by plan)

• An annual deductible

• Copays or coinsurance based on the drug tier

• A coverage gap (also known as the “donut hole”)—though this has been reduced significantly in recent years

Each year, you’ll also have an out-of-pocket maximum after which you pay only a small coinsurance or copay for medications.

What’s Not Covered?

Part D does not cover:

• Over-the-counter medications

• Medications not listed on your plan’s formulary

• Drugs covered under Part B (like those administered in a doctor's office)

Why Medicare Part D Matters

Even if you don’t take many prescriptions now, enrolling in a Part D plan when you're first eligible helps you avoid late enrollment penalties later on.

Plus, having the right drug coverage can save you money and make it easier to manage chronic conditions over time.

How Temecula Medical Group Can Help

If you’re unsure which plan is right for you or you need help reviewing your medication list, just give us a call.

We can:

• Recommend Medicare specialists who can help you pick a plan 

• Coordinate care with your pharmacy

• Help you get prior authorizations when needed

• Recommend generic or cost-effective alternatives

• Assist with medication management and education

Call us at (951) 302-2526 or stop by Temecula Medical Group—we're happy to help you get the most out of your Medicare benefits.

Author

Temecula Medical Group Place of Healing: We strive to make our clinic a healing space for all of our patients through compassionate care and active listening.