Prescription medications are a key part of managing health, especially as we age. But Original Medicare doesn’t cover most drugs you take at home. That’s where Part D coverage comes in. Medicare Part D helps pay for prescription drugs and is available through private insurers. Whether you enroll in a standalone plan or receive Medicare Part D coverage through a Medicare Advantage plan, this benefit helps older adults access and afford the medications they need.
What Is Medicare Part D?
Medicare Part D is outpatient prescription drug coverage offered to people enrolled in Medicare Part A and/or B. Unlike Original Medicare, which is administered by the federal government, Part D plans are offered by private insurers approved by Medicare.
You can get Part D coverage in one of two ways:
- Through a standalone prescription drug plan (also called a PDP), typically added to Original Medicare or a Medicare Supplement plan
- As part of a Medicare Advantage plan that includes Part D coverage (often called an MA-PD)
Align Senior Care’s Medicare Advantage plan includes built-in prescription drug coverage under Part D, so you don’t need to enroll separately or manage multiple plans.
How Does Medicare Part D Work?
Part D coverage follows a structured system that may include multiple cost-sharing stages throughout the year. Most plans include:
- A monthly premium, which varies based on your plan and income
- A possible deductible, which you must pay before coverage kicks in
- Copayments or coinsurance during the initial coverage stage
- A $2,000 out-of-pocket maximum beginning in 2025, which limits what you pay each year
Align Senior Care does not have separate Part D coverage.
Part D plans categorize covered medications into tiers, and the cost you pay depends on which tier your medication falls under. Most formularies (plan drug lists) group medications like this:
- Tier 1 – Preferred generics
- Tier 2 – Generics
- Tier 3 – Preferred brand-name drugs
- Tier 4 – Non-preferred drugs
- Tier 5 – Specialty medications
Once you hit the $2,000 annual out-of-pocket cap, you enter a “catastrophic coverage” phase where you pay nothing for the rest of the year.
What Does Medicare Drug Coverage Include?
Medicare prescription drug plans must cover a wide range of medications, including those commonly used by people with Medicare. All Part D plans must include drugs in key categories such as:
- Antidepressants
- Antipsychotics
- Cancer treatment drugs (oral)
- HIV/AIDS treatments
- Anticonvulsants
- Immunosuppressants
- Insulin and related diabetes supplies
Part D also covers many adult vaccines, including shingles and Tdap, at no cost to the member.
Specific drug lists vary by plan, so it’s important to check the formulary to confirm that your current medications are covered.
Why Prescription Drug Coverage Matters
Without drug coverage, the cost of medications can add up quickly—especially for chronic or specialty prescriptions. Even commonly used generics can become a burden over time. Medicare Part D was designed to help control these costs and give people access to the prescriptions they need to manage their health.
- Key benefits of enrolling in Part D early include:
- Avoiding late enrollment penalties
- Locking in coverage before your medication needs grow
- Paying less out of pocket for common and specialty prescriptions
- Access to pharmacist support and mail delivery programs
- Coverage for preventive vaccines and essential medications
Part D is optional, but delaying enrollment without having other creditable coverage may result in permanent penalties added to your monthly premium.
How Align Senior Care Delivers Part D Coverage
Align Senior Care’s plans include Medicare Part D coverage as part of a bundled Medicare Advantage plan. Members don’t need to sign up separately or manage multiple plans. This integrated structure is especially helpful for seniors in both long-term senior care and senior living communities.
With Align Senior Care’s plans, members receive:
- Comprehensive drug coverage through our plan’s Part D formulary
- Coordination between care providers and pharmacy services
- On-site and mobile care support to help manage medications
- Access to medication therapy management (MTM) programs for those on multiple prescriptions
- Home delivery options for added convenience
Our team coordinates directly with community care staff and pharmacists to ensure medications are filled on time, used safely, and adjusted when needed. That kind of support is hard to match in a fragmented system.
Standalone Part D vs. Medicare Advantage with Drug Coverage
Standalone prescription drug plans are helpful if you’re using Original Medicare or a Medigap plan, but they require separate enrollment and don’t include medical or hospital benefits.
With a Medicare Advantage plan like Align Senior Care Connect, everything is included under one umbrella: medical, hospital, behavioral health, and Part D coverage. This makes it easier to manage care and reduces the risk of coverage gaps.
Here’s a quick comparison:
| Feature | Standalone Part D Plan | Align Senior Care Medicare Advantage Plan |
| Prescription coverage included? | Yes | Yes |
| Medical & hospital benefits? | No | Yes |
| One ID card and care team? | No | Yes |
| Designed for complex conditions? | No | Yes |
| Coordinated care support? | No | Yes |
When and How to Enroll
You can enroll in a Part D plan when you first become eligible for Medicare (at age 65 or due to qualifying disability) during your Initial Enrollment Period. If you miss this window, you can also enroll during the Annual Enrollment Period (October 15 to December 7), or if eligible, during a Special Enrollment Period.
Align Senior Care accepts eligible members year-round, and our team can help walk you through enrollment and benefit coordination. Learn more about our senior health plans today.
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