Tier 1
Preferred Generic
These are commonly available medications produced by many manufacturers. The lowest copayment will be for the lowest-cost version of the drug.
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Medicare Part D coverage and tiers
For many Medicare enrollees, a Medicare Part D Prescription Drug Plan (PDP) is the most cost-effective way to obtain prescription medication. Some Medicare Advantage (Part C) plans also cover certain prescription drugs, but if you take advantage of Original Medicare (Parts A & B) via the federal government, a Part D PDP may be just what the doctor ordered—pun very much intended—for low-cost drug coverage.
Part D PDPs vary by state and insurance carrier, but most offer drug coverage based on a tiered system. Below is an example of a tier system you might find when shopping for a plan—you’ll want to make sure that the drugs you already take or may need soon are covered by the tiers in the plan you choose.
Tier 2
Generic
These medications are similar to those in Tier 1, but there may be fewer options available and the copayments slightly higher.
Tier 3
Preferred Brand
These are brand-name drugs that may not be available in generic form, but are cost-effective compared to other alternatives, and usually require a medium-sized copayment.
Tier 4
Non-Preferred Drug
These cost more than preferred brand drugs. Some plans may not cover these, especially if there is a generic equivalent—otherwise, there may be a high copayment.
Tier 5
Speciatlty Tier
These drugs used to treat ongoing health conditions may have to be ordered through a specialty pharmacy, and if covered, will have very high copayments.
Tier 6
Select Care Drugs
This special tier of prescription drug often has a $0 or very low copayment, and is reserved for drugs that treat common senior-specific conditions such as diabetes, hypertension, and osteoporosis.
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Frequently asked questions about Medicare Part D
How do I enroll in Medicare Part D?
To enroll in Medicare Part D prescription drug coverage, you must be eligible for Medicare. Medicare is generally available to those age 65 and older in the United States; you may also qualify before 65 as the result of certain conditions:
- Some disabilities
- End-stage renal disease (permanent kidney failure requiring dialysis or transplant)
- Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s disease)
To enroll in a Medicare Prescription Drug Plan (PDP), use our Medicare plan comparison tool to find the plan that works best for you and enroll online during a qualifying enrollment period.
When do I enroll in Medicare Part D?
You can enroll in a Medicare Part D PDP during a qualified Medicare Enrollment Period:
- Initial Enrollment Period - beginning 3 months before your 65th birthday, continuing through your birthday month and three months after. During this period, after signing up for Original Medicare, you can enroll in a Prescription Drug Plan
- Annual Enrollment Period - October 15-December 7 each year, available to anyone Medicare-eligible. During this period, you can enroll in Part D coverage for the first time or change or drop your PDP.
- Medicare Advantage Open Enrollment Period - January 1-March 31 each year, available to anyone already enrolled in a Medicare Advantage plan. During this period, you can add or drop prescription drug coverage.
- Special Enrollment Periods - may occur throughout the year, triggered by qualifying events. Depending on your circumstances, you may be able to add, drop, or change your prescription drug coverage.
Who is eligible for Medicare Part D?
Medicare Part D Prescription Drug Plans (PDPs) are available to anyone eligible for Original Medicare (Medicare Parts A & B, coverage provided by the federal government). Medicare eligibility is determined by age or by special qualifying conditions.
- Age: If you are a citizen of the United States who has been living in the U.S. for the previous 5 years and are 65 years of age (or approaching your 65th birthday) you are eligible to sign up for Medicare.
- Qualifying Conditions: You may qualify for early benefits if
- you are disabled and have received Social Security benefits for at least 24 consecutive months;
- you suffer from kidney failure, also known as End-Stage Renal Disease (ESRD), and have had a kidney transplant or been on dialysis for 3 months; or
- you have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease).
How much does Medicare Part D cost?
The cost of Medicare Part D coverage varies by plan. Use our comparison tool to find a plan that best fits your budget. You can even search by particular prescriptions to find plans that cover your medications.
Medicare resources
General Enrollment and Open Enrollment Periods
Learn about the two Medicare enrollment periods that run from January through March.
Medicare Annual Enrollment Period 101
When is the Medicare Annual Enrollment Period? Get answers to this and other AEP-related questions.
Medicare Enrollment Overview
Get fast facts about Medicare Enrollment, including when you qualify and when to enroll.