Medicare Part D

Medicare Part D is a fundamental part of many people’s health insurance. It provides prescription drug coverage and is one of the four parts of Medicare. Understanding prescription drug coverage goes hand in hand with understanding how Medicare operates. We’ll discuss the basics of Medicare and whether or not Part D is the right choice for you.

Medicare Coverage

Medicare is health and hospital insurance issued by the US Government. Its goal is to provide seniors with healthcare and ensure they have access to needed services. It’s typical to enroll in Medicare at the age of 65, though some enroll earlier due to disability.

Medicare coverage is divided up into different parts. When selecting a policy, you’ll be able to choose either Parts A and B, or Part C. Part C is called Medicare Advantage. This type of policy allows you to select your desired areas of coverage and add on features that Parts A and B don’t include.

If you choose Parts A and B, you won’t be able to include coverage changes or modifications within your plan. However, you may be eligible for premium-free Part A if you and/or your spouse has paid the appropriate Medicare taxes. Premium-free Part A is an excellent way to reduce bills and gain access to a wide variety of treatments.

Selecting the right Medicare plan initially is important, as there are specific periods during which you can change your policy. While it is possible to make variations to your plan, it can be a complicated and long process. It’s always best to select the right policy from the start and gain quick access to the coverage it offers. One of the best ways to do this is by working with an insurance agency that understands Medicare.

Medicare Parts​

Medicare is divided up into four parts. Each of these parts provides for a different area of medical coverage. Understanding the various parts is extremely important in knowing which policy you’ll select and the coverage you’re enrolling in. If you’re not sure about which policy or parts are right for you, don’t hesitate to reach out to an insurance agent. At Legacy Peace Of Mind, Inc, we make sure that all our clients have their questions answered. Make an appointment today to speak with one of our professionals and learn more about the options available to you.

Medicare Part A primarily covers inpatient care. Hospital costs can be extremely expensive, so Part A steps in and provides varying coverage in these situations. Part A also covers care provided in a skilled nursing facility. Though hospital stays and nursing facility admittance can be lengthy, Medicare is not intended to cover any long term stays. There are determined periods in which Medicare will pay for a certain amount, with that amount decreasing as time goes on.

While there are some guidelines set for what Medicare will cover, it’s important to remember that situations are evaluated on a case-by-case basis and there are many determinants that are taken into account. Medicare Part B covers both medically necessary and preventable services. This includes some durable medical equipment, clinical research and mental health treatment. Some prescription drugs are covered through Part B. However, this list is very limited and is not intended to be relied upon for prescription drug coverage.

Medicare Part B places an emphasis on preventative care. This is important to note, as Medicare prioritizes the health of its beneficiaries and understands the need for screening and other similar methods. If you’re wondering what type of care Medicare provides for, know that its coverage extends to many different situations and health is always at the forefront.

Medicare Parts A and B combine to make Original Medicare. Many are automatically enrolled in Original Medicare and find that it meets their health insurance needs. While prescription drugs are not covered through Original Medicare, those enrolled do have the option to add on Part D. We’ll discuss that further in a moment.

Part C, or Medicare Advantage, will always include the coverage that Original Medicare does. However, it gives the option to build coverage into your plan. If you would like vision, dental or hearing coverage through Medicare, consider purchasing a Part C policy.

Medicare Part D is prescription drug coverage. It’s available to those enrolled in Original Medicare, but those enrolled in Part C are not eligible. If you’d like to enroll in Part D, you’ll need to choose an Original Medicare policy.

Prescription Drug Coverage

While some prescription drugs are covered through Part B, Medicare intends Part D to be the primary source for prescription drug coverage. Part D is divided up into different tiers, each of which covers a different area of medication.

Prescription drug coverage is important for multiple reasons. Medication can be extremely expensive. Enrolling in Part D is an excellent way to protect yourself from those costs and be sure you’ll be prepared if you need to take a trip to the pharmacy.

Even if you don’t currently take any medications, you should still consider Part D. Common conditions, such as diabetes, can require thousands of dollars worth of supplies and treatments. You never know when you might wish you had enrolled in Part D, so don’t wait until that moment. Take the chance now and speak with an insurance professional about what it would mean for you to enroll in Medicare Part D.

Those enrolled in Part C are not eligible for Part D. This is because prescription drug coverage can be added into Part C. If you’re happy with your Original Medicare policy, or are interested in making a change, consider what Part D offers. Part D divides prescription drug coverage into four tiers, each corresponding to a different level of medication.


The four drug tiers provide an excellent design for selecting coverage and ensuring the drugs you need are included in your policy. Each tier provides a varying level of coverage. It’s important to remember that the drugs within each tier can change, but more on that later.

Tier 1 is the least expensive option. Its copayment is extremely affordable for most. It covers generic drugs, but still can significantly reduce costs. Even common medications can be expensive, so enrolling in Tier 1 is an excellent way to make sure those costs are manageable. Tier 1 is most likely the best option for those looking for general medication coverage. It’s not intended for those with specialized medication but can suffice if you don’t regularly take complex medications and are looking for generalized drug coverage.

Tier 2 offers more drug coverage than the former, as it includes preferred medication. Brand-name accessibility is also offered through Tier 2. This option is a step up from the first tier and its copayment reflects that. When it comes to drug coverage, copayment and complexity will increase simultaneously.

Tier 3 has the second to highest copayment and that is reflected in the drug coverage. It includes expensive prescription drugs. If you regularly take a high-cost medication, this is most likely the right option for you. It will provide you with exceptional coverage and provide for the cost of most medications. With this coverage selection, you won’t need to worry about the cost of most medications and will have access to the prescriptions you need.

The Specialty Tier is the highest tier available and it has the most expensive copayment. If you’re looking for holistic medication coverage, regardless of how preferred the prescription is, this is most likely the right option for you. While the copayment is high, its extensive offerings make it worth it for most. If you’re anticipating needing an expensive medication, consider enrolling in this tier and gaining access to the coverage it provides.

How to Choose a Part D Policy

Choosing a Part D policy is fairly simple for many. By taking a look at the different tiers, you can see which medications are covered. While you should primarily pick based on the medications you currently take regularly, keep in mind your past medical coverage. Was there a time when you wish a certain medication had been covered? If so, consider picking a tier that includes it.

Keeping the future in mind is important when making insurance decisions. Any health problems you’ve had in the past should be taken into account, as it’s possible they could come back. Insurance is all about planning for the future, so make sure to think about all the possibilities and select your coverage accordingly. Remember to take a look at the specific tiers and formularies included with Part D. This is essential in making sure that you know what coverage you’re selecting and the medication it includes.

Part D Changes

Medicare Part D plans can change every single year. While there are a few reasons for this, it’s primarily because new medications and therapies are continually released. Medicare shifts and evolves with the healthcare field, so it makes complete sense that prescription drug policies would change as well.

If your Part D plan has changed and no longer includes the medication you need, speak with an insurance agent about your options. You can also reach out to your doctor and see if they have any recommendations. Even though your previous medication may no longer be covered, there may be a comparable one that’s now included within your policy. Speaking with your primary care provider is an excellent way to make sure your insurance and medications are working together to keep you healthy and your bills manageable.

If your drug plan is going to change, you’ll be given notice. You’ll be given written notice that explains the prescription you use is no longer going to be covered. This is incredibly important to watch out for and take seriously. It could mean that you need to change plans and reevaluate your coverage.

You deserve to have drug coverage for the medication you need. If you no longer have coverage in an area, speak with your insurance provider about what can be done. Don’t settle for less and make sure that you have access to the medication you need.

VA Benefits and Part D

It’s possible to be simultaneously enrolled in Medicare and VA benefits. In fact, for those eligible, this may be the best option. It can lower bills and grant access to various treatment options and centers.

If you’re using both types of benefits for your general healthcare needs, know that won’t be possible when purchasing prescription drugs. You can only use one type of coverage for one drug at a time. For example, you can’t use your VA benefits for one drug and then have Medicare cover any remaining cost you’ll need to pay. While you can use VA benefits and Medicare in that way for other health services, it’s not possible when purchasing medications. You can still be enrolled in both and use both kinds of coverage for medications, just not at the same time.

If you still have questions about VA benefits and Medicare, don’t hesitate to reach out. Our professionals at Legacy Peace Of Mind, Inc are leaders in the Colorado insurance field and understand the importance of knowing the details of your policy and how it interacts with other types of insurance. Before making any big decisions, give us a call and set up an appointment to ask your questions and get the clarification you need.

Enroll today!

Whether you’re just beginning your Medicare journey or starting to look into other options, we’re here to help. Our team at Legacy Peace Of Mind, Inc has extensive training in the details of Medicare and understands the importance of having all your questions answered. We’re here to help you through the initial enrollment process and will also be here if you need to make any changes to your policy in the future.

Making an appointment with us means gaining access to one of Colorado’s most prestigious insurance agencies. We look forward to hearing from you and partnering to ensure you have the best policy for your situation.

If you have any additional questions related to Medicare, our team of Colorado Medicare experts is happy to help you. Contact us at 970-233-0063 today.