What Does Medicare Part D Cover? Prescription Drug Coverage Explained
Key takeaways:
Medicare Part D covers prescription medications, vaccines, and certain medical supplies.
To avoid a late enrollment penalty, sign up for Part D as soon as you become eligible for Medicare — unless you have another prescription plan that meets or exceeds Part D coverage.
There are many Medicare Part D plans available with different monthly premiums, coverage, and deductibles.
Table of contents
If you are newly eligible for Medicare, have recently enrolled, or have had this insurance for a while, you may wonder about prescription coverage. About 89% of people in the U.S. age 65 and older report taking at least one prescription medication.
Part D is the Medicare program that helps cover prescriptions. Here’s a look at what Medicare Part D covers, how it works with other Medicare coverage, and how to enroll.
What is Medicare Part D, and how does it work?
Medicare Part A is hospital insurance. Medicare Part B is medical insurance that covers outpatient and preventive care, such as visits with healthcare professionals. Medicare Part D covers prescription medications.
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There are several ways to get prescription medication coverage with Medicare:
Having original Medicare — Part A and/or Part B — and buying a stand-alone Part D plan
Having a Medicare Advantage plan that includes Part D
Having a Medicare Advantage plan that doesn’t include prescription coverage and buying a stand-alone Part D plan
Even if you don’t take prescription medications now, you may want to enroll in Part D coverage when you first sign up for Medicare. There is a late enrollment penalty that you can avoid if you sign up for Part D as soon as you’re eligible for Medicare. There is no penalty if you have creditable coverage — another prescription plan that meets Medicare’s standard. The available Part D plans will depend on where you live.
What does Medicare Part D cover?
Medicare Part D covers many brand-name and generic prescription medications. These plans also cover certain medical supplies, as well as some vaccines and their administration.
Vaccines covered by Medicare Part D include:
DTaP-IPV-Hib-HepB, a combination of diphtheria, tetanus, pertussis (whooping cough), inactivated polio virus, Haemophilus influenzae, and hepatitis B
DTaP/Tdap/Td, a combination of diphtheria, tetanus, and pertussis
Medicare covers most vaccines: Medicare Part D covers most vaccines, including respiratory syncytial virus, or RSV. But COVID-19, flu, and pneumonia shots are covered by Medicare Part B.
You may save big with the new Part D spending cap: Medicare Part D has a $2,000 out-of-pocket limit in 2025, and enrollees with costly medications are expected to save the most.
Medicare prescription payment plans: In 2025, Medicare Part D enrollees will have the option to make payments for prescription medication costs instead of paying up front at the pharmacy.
What medications are not covered by Medicare Part D?
Part D plans do not cover all medications and treatments. Here are some of the medications not covered by Part D:
Cosmetic medications, such as hair-growth treatments
Erectile dysfunction medications
Fertility medications
Medications covered by Part A or Part B
Medications not approved by the FDA for sale in the U.S.
Over-the-counter medications, such as vitamins, even if prescribed
Weight-loss medications solely for losing weight (but if these medications are used to treat other conditions, such as Type 2 diabetes, or to reduce the risk of heart attack, stroke, or other severe cardiovascular event, they may be covered)
How do I find a plan that covers my medications?
To find plans that cover the medications you take, use the Medicare Plan Finder. All Part D plans have a formulary, which is a list of what they cover. Each formulary must include at least two medications in the most commonly prescribed categories. They also must cover all treatments in six “protected” classes, including antidepressants and antipsychotics.
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How do you enroll in a Medicare Part D plan?
You can join Medicare Part D by enrolling in a Medicare Advantage plan with prescription medication coverage. Or you can choose a stand-alone Part D plan if you have original Medicare or a Medicare Advantage plan without prescription coverage.
Choose a Medicare Part D plan that aligns with your needs and budget. Once you’ve chosen a plan, you can enroll in several ways:
Use the Medicare Plan Finder.
Complete a paper enrollment form.
Call the plan’s customer service line.
Call Medicare at 1-800-MEDICARE (1-800-633-4227).
What is the average cost of a Medicare Part D plan?
Part D costs include monthly premiums and out-of-pocket expenses when you fill prescriptions. In 2025, Part D costs are as follows:
Premium: Varies by plan, but the average projected premium is $46.50 and $40 for stand-alone Part D plans, according to the Centers for Medicare & Medicaid Services. Part D may be included in your Medicare Advantage plan. Your premium might be up to $85.80 more per month if you have a high income. You can get assistance paying for your premium if you qualify for the Extra Help low-income subsidy.
Deductible, copayments, and coinsurance: Vary by plan and pharmacy, but the deductible can’t exceed $590.
Out-of-pocket limit: Beginning on January 1, 2025, you are responsible for no more than $2,000 of your prescription costs in a year. Your plan pays 100% of your costs after you reach that spending cap.
Can changing your Medicare Part D plan save you money?
Choosing the right Medicare Part D plan for you can save you money, and selecting the wrong one can cost you more. If you find a plan that covers the medications you need and reduces your out-of-pocket costs, you may want to change plans.
There are several ways to save with your Part D plan. They include:
Choosing a plan with a lower monthly premium
Finding a plan that includes the medications you take
Finding a plan with low or no deductible
Choosing a plan with tiers that charge no copays or low copays for generic medications if you take them
Switching to a Medicare Advantage plan that includes prescription coverage that covers the medications that you take
When you can change your plan depends on your coverage:
Original Medicare: You can change Part D plans every year during Medicare open enrollment, which is October 15 to December 7.
Medicare Advantage: In addition to Medicare open enrollment (October 15 to December 7), you can change to another Medicare Advantage plan from January 1 to March 31. (If you change to a stand-alone Part D plan, you will be switched to original Medicare.) You may qualify for a special enrollment period at other times if you have a change in your life, such as moving to a new address outside your plan’s service area.
If you need help choosing the best plan for you, call 1-800-MEDICARE (1-800-633-4227) or contact the State Health Insurance Assistance Program for free assistance from trained counselors.
Regardless of your insurance coverage, you can use GoodRx to save on your prescriptions.
Frequently asked questions
Medicare Part D may be beneficial if you have prescription medications. Your monthly premium may be worth it because you could pay lower out-of-pocket costs for medications, instead of the pharmacy’s retail price. Starting in 2025, Medicare Part D enrollees can join a prescription payment plan. This option can help you get medications when they need to be filled, avoid full payment at the pharmacy when you pick up prescriptions, and spread your out-of-pocket costs over the year. Also in 2025, there is a $2,000 out-of-pocket cap, which is expected to benefit enrollees who have costly medications.
In 2025, Part D enrollees won’t have any additional out-of-pocket costs for covered medications after spending $2,000. That amount will be adjusted for inflation in future years. When you reach the out-of-pocket maximum, you’ll be in the catastrophic coverage phase. At that time, your plan will pay 100% of the costs of covered medications for the rest of the year.
Medicare Advantage meets or exceeds the benefits of original Medicare. But Medicare Advantage plans have drawbacks, so they aren’t a good fit for everyone. When compared with original Medicare, these disadvantages include:
Limited provider networks
Annual benefit changes, especially for additional perks
No option to join a Medigap supplement insurance plan
Wider use of prior authorization
Higher end-of-life costs
Medicare supplement plans known as Medigap typically cover some of your out-of-pocket costs if you have original Medicare. Medigap can’t be combined with Medicare Advantage. Your Medigap plan will cover everything if you have certain plans and you reach their out-of-pocket limits. Those out-of-pocket limits in 2025 are $7,220 for Plan K and $3,610 for Plan L. After that, Medigap will pay 100% of approved services for the rest of the year.
The bottom line
Medicare Part D plans cover brand-name and generic prescriptions, as well as some vaccines and medical supplies. This coverage is often included with Medicare Advantage plans. But if it isn’t, you’ll need stand-alone prescription coverage. If you have original Medicare, you need to buy a separate Part D plan. Choosing the right plan for your needs can save you money.
To avoid the late enrollment penalty, sign up for a Part D plan as soon as you’re eligible for Medicare — unless you have another prescription plan that meets Medicare’s standard.
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References
Center for Medicare Advocacy. (n.d.). Part D / prescription drug benefits.
Centers for Medicare & Medicaid Services. (2024). K & L out-of-pocket limits announcements.
Centers for Medicare & Medicaid Services. (2024). Medicare Advantage and Medicare prescription drug programs to remain stable as CMS implements improvements to the programs in 2025.
Cohen, R. A., et al. (2024). Prescription medication use, coverage, and nonadherence among adults age 65 and older: United States, 2021–2022. National Center for Health Statistics.
Cubanski, J. (2024). A current snapshot of the Medicare Part D prescription drug benefit. KFF.
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Medicare.gov. (n.d.). Costs. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Drug coverage (Part D). Centers for Medicare & Medicaid Services.
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Medicare.gov. (n.d.). How to get prescription drug coverage. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Monthly premium for drug plans. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Special enrollment periods. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). What Medicare Part D drug plans cover. Centers for Medicare & Medicaid Services.
Medicare.gov. (n.d.). Yearly deductible for drug plans. Centers for Medicare & Medicaid Services.
