Tiers
Covered drugs are grouped into cost levels. The same medication can sit in different tiers on different plans.
Part D
Medicare Part D Prescription Drug Plans, Explained
How prescription coverage works under Medicare, what a formulary actually is, and why the right plan depends on the medications you take.
To speak with a licensed insurance agent, call (662) 210-2200. TTY: 711.
How it works
Two ways to get drug coverage
Medicare prescription drug coverage is offered by private insurance companies approved by Medicare. You can get it as a stand-alone plan that sits alongside Original Medicare, or bundled into a Medicare Advantage plan that includes drug coverage.
Either way, each plan sets its own list of covered drugs and its own pharmacy network. That is why two people in the same town, taking different medications, often belong on different plans.
Formularies
Covered drugs and cost tiers
A plan's formulary groups covered medications into tiers. Generally, lower tiers hold lower-cost drugs and higher tiers hold higher-cost or specialty drugs, with your share of cost rising as the tier rises.
Some drugs also carry requirements such as prior authorization, quantity limits, or step therapy. We describe these categories generically here — the actual placement of your prescriptions is specific to each plan and each plan year.
Pharmacy network
Plans contract with specific pharmacies, and your share of cost can differ depending on which one you use.
Coverage rules
Prior authorization, quantity limits, and step therapy may apply to certain drugs on a plan's list.
Coverage phases
Costs can change during the plan year
Part D coverage moves through cost phases within a single plan year, and what you pay for a prescription can differ depending on which phase you are in at the time.
The thresholds that move you from one phase to the next are set annually by Medicare and change from year to year, so we do not quote figures here. The practical step is to review the specific plan's own documents for the current year, which we are glad to do with you.
Timing
The late enrollment penalty
If you go without creditable prescription drug coverage for an extended period after you first become eligible, a late enrollment penalty can apply and generally stays attached to your premium going forward.
Creditable coverage can come from sources other than a Part D plan, including some employer or retiree plans. If you are delaying enrollment because you already have coverage, it is worth confirming that it counts.
Questions
Part D questions
To speak with a licensed insurance agent, call (662) 210-2200. TTY: 711.
This page is general education about how Medicare prescription drug coverage is structured. Cost figures, coverage phase thresholds, and penalty calculations are set annually by Medicare and are not quoted here. Please confirm current details with a licensed insurance agent or at Medicare.gov.
Want your medication list checked against a plan's formulary?
No pressure, no obligation — just a conversation with a licensed insurance agent about the options available to you.
To speak with a licensed insurance agent, call (662) 210-2200. TTY: 711.
Medicare Compliance Statement
This website represents no obligation to enroll. Not affiliated with or endorsed by the government or Federal Medicare program. Magnolia Family Insurance is an independent insurance agency. We represent multiple insurance carriers to help you find the plan that best fits your needs.
Medicare has neither reviewed nor endorsed this information. As an independent agency, Magnolia Family Insurance offers comparison services to find the best plan for your needs from multiple carriers. For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week, or consult www.medicare.gov.