Does Medicare Part D only cover prescription drugs?

Asked by: Antone Renner  |  Last update: November 1, 2025
Score: 4.9/5 (59 votes)

Medicare Part D, the prescription drug benefit, is the part of Medicare that covers most outpatient prescription drugs. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with your Medicare Advantage Plan.

What will Medicare Part D not cover?

The following will not be covered: Drugs not listed on a plan's formulary. Drugs prescribed for anorexia, weight loss or weight gain. Drugs prescribed for fertility, erectile dysfunction, cosmetic purposes or hair growth.

Does Medicare Part D pay for all drugs?

Beginning on January 1, 2006, Medicare will pay for all or most of your prescription drugs. This change in coverage is called “Medicare Part D.”

Can Medicare Part D be offered as standalone prescription drug coverage?

You can get Part D through a stand-alone prescription drug plan or through an all-in-one Medicare Advantage plan. Part D involves cost sharing, and the amount you will pay out of pocket for prescriptions can vary throughout the year.

What does Medicare Part D cover for seniors?

Medicare drug coverage (also known as Medicare Part D) helps pay for the brand-name and generic drugs you need. It's offered to everyone with Medicare by insurance companies and other private companies approved by Medicare. You can get drug coverage 2 ways: Add Medicare drug coverage (Part D) to Original Medicare.

What does Medicare Part D Cover?

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What are the disadvantages of Medicare Part D?

Disadvantages of Medicare Part D Prescription Drug plans include:
  • Need to anticipate your prescription drug needs for the year: Part D plans differ in the types of drugs they cover. ...
  • Plans differ from insurer to insurer: Part D plans must offer a minimum amount of coverage per Medicare, but otherwise plans can differ.

How much does the average person pay for Medicare Part D?

The average estimated monthly Part D plan premium in 2025 is $46.50. Other factors can affect the cost of Part D including monthly premium, yearly deductible and copayments. High-income earners may pay a surcharge known as the “income-related monthly adjustment amount” (IRMAA).

What is the $2000 limit for Medicare Part D?

Thanks to the Inflation Reduction Act, in 2025 annual out-of-pocket costs will be capped at $2,000 for people with Medicare Part D.

Can I buy a stand-alone prescription drug plan?

These are standalone plans that can be purchased through private insurance companies. PDPs provide coverage for prescription drugs and medications and may also cover some vaccines too. Original Medicare (Parts A & B) doesn't provide prescription drug coverage.

What is the most popular Part D drug plan?

The best Medicare Part D provider is Aetna. It has top ratings from the Centers for Medicare & Medicaid Services and affordable premiums. Other great providers include Wellcare and UnitedHealthcare.

Is Medicare Part D worth it?

No, Medicare Part D isn't a requirement. However, many people find that enrolling in a Part D plan is worth the investment. Your health can be unpredictable, so while you may not need many (or any) prescription drugs now, you may need them in the future.

How do I know if a drug is covered by Medicare Part D?

Each Part D plan has a list of covered drugs, called its formulary. If your drug is not on the formulary, you may have to request an exception, pay out of pocket, or file an appeal. A drug category is a group of drugs that treat the same symptoms or have similar effects on the body.

What happens if I refuse Medicare Part D?

If you don't sign up for a Part D plan when you are first eligible to do so, and you decide later you want to sign up, you will be required to pay a late enrollment penalty equal to 1% of the national average premium amount for every month you didn't have coverage as good as the standard Part D benefit.

Do you automatically get Part D with Medicare?

Note: If you are enrolled in Medicaid and become eligible for the Medicare drug benefit, you will usually be automatically enrolled in a Medicare Part D plan and pay no premium for it. If you are in Medicaid and do not want the Medicare drug benefit, call your local Medicaid office.

Does Medicare Part D cover weight loss medication?

Under current law, people on Medicare can get anti-obesity drugs covered by Part D, Medicare's outpatient drug benefit, only if they are used for a medically accepted FDA-approved indication other than obesity, like diabetes or cardiovascular disease risk reduction.

Which Medicare part covers only prescription drugs?

While Medicare Part D covers your prescription drugs in most cases, there are circumstances where your drugs are covered under either Part A or Part B. Part A covers the drugs you need during a Medicare-covered stay in a hospital or skilled nursing facility (SNF).

What is stand-alone Medicare Part D?

(also known as Medicare Part D) helps pay for the brand-name and generic drugs you need. It's optional and offered to everyone with Medicare by insurance companies and other private companies approved by Medicare. Even if you don't take prescription drugs now, consider getting Medicare drug coverage to avoid paying a.

Why isn't my insurance covering my medication?

This is one of the most common reasons coverage is denied for a prescription. Certain medications require prior authorization – or approval – from your health insurance company. This means your insurer will deny coverage until your healthcare provider fills out certain forms indicating why you need that medication.

Does everyone have to pay $170 a month for Medicare?

Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.

Why is Social Security no longer paying Medicare Part B?

There could be several reasons why Social Security stopped withholding your Medicare Part B premium. One common reason is that your income has exceeded the threshold for premium assistance. Another reason could be that there was a mistake or error in your records.

What is the monthly cost for Medicare Part D?

Medicare Part D premiums range from $0 to $190.80 per month in 2025 for stand-alone plans. Additional charges apply if you enroll late, have an extended gap in drug coverage or have a high taxable income.

Is GoodRx better than Medicare Part D?

Consider using a GoodRx coupon instead of Medicare in the following situations: Your medication isn't covered by your Medicare plan. The medication costs less with a GoodRx coupon than with your Medicare copay. You don't expect to reach your annual deductible.

Is Medicare Part D free for seniors?

1. Medicare Part D is not free. While Part D provides important benefits, it's not free for most people. Below are some of the out-of-pocket expenses you can expect to pay in 2025.

What are the top 5 medicare supplement plans?

💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.