How to learn about you have Part D right now

The fastest way to know if you have Medicare Part D is to look at your insurance card. Part D is the prescription drug coverage piece of Medicare, and your card will say "Part D" or list a pharmacy benefit manager name like CVS Caremark, Express Scripts, or Humana. If you see a card that says "Medicare Advantage" or "Part C", you may have drug coverage built into that plan instead — ask your plan directly.

If you do not have a physical card, log into your Medicare account at Medicare.gov using your username and password. Go to "My Health Care" and select "Coverage". The page will list every part of Medicare you have active right now, including Part D. If you cannot remember your login, you can create one using your Social Security number and email address.

You can also call Medicare directly at 1-800-MEDICARE (1-800-633-4227). Have your Social Security number ready. They will tell you whether Part D is active on your account and, if it is, which insurance company runs your plan.

Key Takeaways

  • Your Medicare card or your Medicare.gov account will show whether Part D is active on your coverage right now.
  • Part D is separate from Original Medicare (Parts A and B) and is not automatic — you must have chosen it or be in a Medicare Advantage plan that includes it.
  • If you turned 65 and did not choose Part D when you first became may be able to access, you may owe a penalty if you sign up later.
  • You can call 1-800-MEDICARE to confirm your Part D status without logging in online.

What Part D actually covers and what it does not

Part D pays for prescription drugs at pharmacies, but it does not cover all drugs and does not cover all costs. Each Part D plan has a formulary — a list of drugs the plan will pay for. Your plan may not cover the exact drug your doctor prescribed, or it may require you to try a cheaper drug first. You can search your plan's formulary on Medicare.gov or call your plan's customer service number (on your card) to ask whether a specific drug is covered.

Part D does not cover over-the-counter medications, dental drugs, or drugs used for cosmetic purposes. It also does not cover most drugs used in hospitals or nursing homes — those are covered under Part A instead. If you are in a hospital or skilled nursing facility, ask the facility's pharmacy staff what is covered; do not assume your Part D plan pays.

When you should have chosen Part D but did not

Part D is not automatic. When you first became may be able to access for Medicare at 65, you had a window to choose a Part D plan. If you did not choose one during that window and you did not have other drug coverage (like coverage from an employer or union), you may now owe a late enrollment penalty every month you are on Medicare.

The penalty is roughly 1 percent of the national average Part D premium for each month you went without coverage. If you went without Part D for two years, for example, your penalty would be about 24 percent of the average premium added to your monthly cost, and it stays with you for as long as you have Part D. You can still sign up for Part D during the annual open enrollment period (October 15 to December 7 each year), but the penalty will explore when ready.

If you had other creditable drug coverage — from a former employer, a union, the VA, or TRICARE — you may not owe a penalty. Call your old employer's benefits office or your union to ask whether they considered their coverage "creditable" under Medicare rules. If it was, keep that documentation; you may need it to avoid or reduce the penalty.

Part D versus Medicare Advantage drug coverage

If your card says "Medicare Advantage" or "Part C", you have a different type of plan that includes drug coverage built in. You do not need a separate Part D plan. Medicare Advantage plans are run by private insurance companies and often have lower out-of-pocket costs than Original Medicare plus Part D, but they usually have smaller networks of doctors and pharmacies.

If you have Medicare Advantage and want to know what drugs are covered, look at your plan's formulary the same way you would for Part D — search on Medicare.gov or call your plan's number. The coverage rules are similar: the plan has a list of covered drugs, may require you to try a cheaper option first, and charges you a copay or coinsurance at the pharmacy.

You cannot have both a separate Part D plan and Medicare Advantage at the same time. If you switch from Medicare Advantage to Original Medicare, you will need to choose a Part D plan during the switch or during the annual open enrollment period.

How to read your Part D plan documents

When you first chose your Part D plan, you received a Summary of Benefits and Coverage (SBC) document. This is the clearest place to see what your plan covers. It lists the drugs covered, the copay amounts, and any rules like prior authorization (when the plan requires approval before paying). If you cannot find your SBC, call your plan's customer service number and ask them to mail or email you a copy.

Your plan also sends you an annual notice of changes in the fall, usually in September or October. This notice tells you what is changing for the next year — new copay amounts, drugs being added or removed from the formulary, or changes to the pharmacy network. Read this notice carefully, because it is your signal to switch plans if the changes do not work for you. You can switch during the annual open enrollment period.

What to do if you think you should have Part D but do not

If you are on Original Medicare (Parts A and B) and you do not have Part D coverage, you can sign up during the annual open enrollment period from October 15 to December 7. Coverage starts January 1 of the following year. You can also sign up if you have a may have access to life event — losing employer coverage, moving to a new state, or getting married, for example. Call Medicare at 1-800-MEDICARE to ask whether your situation qualifies.

If you missed the enrollment window and do not have a may have access to life event, you will have to wait until the next annual open enrollment period. In the meantime, ask your doctor whether any of your prescriptions have a generic version or a lower-cost alternative. Some pharmacies also offer discount programs for people without insurance — GoodRx and SingleCare are two common ones, though they are not part of Medicare.

Frequently Asked Questions

Does Part D cost extra on top of my Medicare premium?

Yes. Part D is a separate insurance product with its own monthly premium, which varies by plan and by year. You also pay a copay or coinsurance when you fill a prescription. Original Medicare (Parts A and B) has its own premiums and costs, so your total Medicare costs include all of these.

Can I switch Part D plans if I do not like mine?

Yes, during the annual open enrollment period from October 15 to December 7. You can switch to a different Part D plan or switch to a Medicare Advantage plan that includes drug coverage. The new coverage starts January 1. Outside this window, you can only switch if you have a may have access to life event.

What happens if my doctor prescribes a drug that Part D does not cover?

Ask your doctor whether there is a similar drug on your plan's formulary that would work instead. If not, you can ask your plan for an exception — a formal request to cover the drug anyway. Your doctor usually has to submit this request. It can take a few days to a few weeks for the plan to decide.

Do I have to use a specific pharmacy for Part D?

Most Part D plans have a network of pharmacies where you pay the lower copay amount. You can use an out-of-network pharmacy, but you will pay more. Your plan's customer service number or website will show you which pharmacies are in your network.

If I have Part D, do I still need to pay for vaccines?

Part D covers some vaccines, but not all. Flu and pneumonia vaccines are usually covered under Part B instead, with no copay. Ask your pharmacy or doctor which part of Medicare covers the vaccine you need.