Medicare Part D prescription coverage is an optional plan that helps cover the cost of prescription drugs. Part D plans are available exclusively through private insurance companies approved by Medicare. You can also get Part D coverage through a Medicare Advantage plan (known as Part C). If you enroll in Part D, you’ll pay a monthly premium.

To help you decide if Medicare Part D prescription coverage is right for you, learn about coverage basics below and what to consider before choosing a plan or deciding not to enroll.

What does Part D cover?

The three most important terms you need to know are formulary, tiers and pharmacy network.

Formulary: Each Part D plan has a formulary, which is a list of covered drugs. It includes a wide range of prescription medications categorized into different tiers.

Tiers: Each tier has a different cost-sharing amount for medications. Lower tier drugs usually have lower copayments or coinsurance.

Pharmacy network: Part D plans have a network of pharmacies where members can fill their prescriptions. It is important to choose a plan with pharmacies that are convenient for you.

Does Part D have a late enrollment penalty?

Not enrolling in Part D when you are first eligible – or if you don’t have creditable coverage – may result in a late enrollment penalty. Before you decide not to enroll, learn how this penalty is calculated and how it could affect your premiums (if you decide to sign up later).

Do I need to enroll in Part D if I have other creditable coverage?

If you have other creditable prescription drug coverage, you may not need to enroll in Part D, such as if you have coverage through an employer or union and it provides equal or better drug coverage.

Do I need to enroll if I have job-based drug coverage?

If you have job-based drug coverage, it is essential to know if your coverage is considered creditable coverage. Contact your benefits administrator to help you determine if you need to enroll in Part D to avoid late enrollment penalties.

What are my options for prescription coverage?

Our licensed agents can help you learn about your options through Sanford Health Plan. Call us toll-free at (888) 605-9277 (TTY: 711) from 8 a.m. to 8 p.m. local time, Monday through Friday, or shop and compare plans online.

To download our free prescription coverage guide, click here. If you’d like to learn about our Medicare Advantage plans, attend an in-person or virtual workshop in your area.

Align powered by Sanford Health Plan is a PPO with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health Plan complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.