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What is Medicare Part D Prescription Drug Coverage?
Find out how Medicare Part D works, what it costs, and more.
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What is Medicare Part D?
Medicare Part D Prescription Drug plans are part of the government’s Medicare program, but they are offered and managed through approved private insurers, like Cigna HealthcareSM. These plans help lower the cost of prescription drugs that can prevent complications from disease and help keep you healthy.
If you are entitled to Original Medicare Part A and/or enrolled in Medicare Part B, there are 2 ways you can get Part D Prescription Drug coverage.
- Enroll in a separate, or standalone, Medicare Part D Prescription Drug plan (when you turn 65 or during Open Enrollment).
- Choose to join a Medicare Advantage plan (Part C) that includes drug coverage. Not all Medicare Advantage plans include drug coverage. Review the details of any plan before you enroll.
Part D: Prescription Drug Coverage
Part D plans are part of the government’s Medicare program, but they’re offered and managed through approved private insurers, like Cigna Healthcare. Enrollment in a separate Part D plan is not automatic. You need to select and enroll in a plan.
Find out more about Medicare Part D Prescription Drug PlansLooking for a Medicare Part D plan?
What are the pros and cons of Part D Prescription Drug plans?
Advantages of Medicare Part D Prescription Drug plans include:
- Cost protection: Part D plans help protect against high-cost prescription drugs by offering various levels of cost coverage for different “tiers” of drugs.
- Low premiums help make these plans affordable.
- Flexible plan options: Part D plans offer you choices in cost and benefit levels depending on your needs and other coverage you may have.
- Works with Medicare Part A and Part B (Original Medicare), or may be included in a Medicare Advantage plan (Part C).
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. Knowing your medical situation can help you select a plan that is right for you and covers the prescription drugs you expect to need.
- Plans differ from insurer to insurer: Part D plans must offer a minimum amount of coverage per Medicare, but otherwise plans can differ. This means you need to shop around and educate yourself on what each plan covers.
- Not all drugs are covered: Each plan has its own drug list (formulary), level of cost coverage, and monthly premium.
- Late Enrollment Penalty (LEP): Fail to enroll in a Part D plan when you are eligible and you may end up paying a late enrollment penalty. For every month you delay enrolling, Medicare will charge you a small fee, which is added to your monthly premium.
Learn more about Medicare Part D Enrollment and the LEP
How do Medicare Part D plans work?
Currently, a typical Part D plan has 3 phases and works like this:
- Deductible and Initial Coverage: The “typical” plan has an annual deductible. After you have paid costs equal to the deductible amount, then you have Initial Coverage. In this phase, you will only pay a copay or coinsurance on covered prescription drugs until you reach the Initial Coverage Limit, which starts the Coverage Gap.
- Coverage Gap: Also known as the “Medicare donut hole.” Here you pay a discounted amount for brand and generic drugs. Once your combined drug costs reach the upper level of the Coverage Gap, you move to Catastrophic Coverage.
- Catastrophic Coverage: Starting in 2024, the plan pays the cost for covered prescription drugs for the remainder of the year.
Starting in 2025, a typical Part D plan will still have 3 phases but will work a little differently:
- Deductible: The “typical” plan has an annual deductible. After you have paid costs equal to the deductible amount, then you have Initial Coverage.
- Initial Coverage: In this phase, you will only pay a copay or coinsurance on covered prescription drugs. You remain in this phase until you reach $2,000 in out-of-pocket costs.
- Catastrophic Coverage: After you have spent $2,000 in out-of-pocket costs, you will pay $0 for the remainder of the calendar year.
Are all Part D plans the same?
Medicare requires Part D plans to provide a minimum standard level of coverage, but beyond that plans can differ in level of coverage, drug lists, and monthly premiums.
What drugs are covered by Medicare Part D?
Part D plans help pay for medications you take regularly to manage chronic conditions, for example, heart disease, high cholesterol, or asthma. It also pays for medications you take for a short period of time, such as antibiotics. There are also some medications covered by your Original Medicare Part B (Medical) plan and not covered by Part D.
Read more about Part B vs. Part D
What costs are involved in a Part D Prescription Drug plan?
Costs you pay out-of-pocket for a Part D prescription drug plan include the following:
- Part D monthly premium: This is a flat fee you may have to pay to your plan for providing you with coverage.1
- Part B premium: You must continue to pay Part B premiums as part of your Original Medicare coverage.
- Copays and coinsurance: You and Medicare share a percentage of the costs for your prescription drugs. This means you pay part of your pharmacy drug costs (copays and coinsurance) and Medicare (through your plan) also pays part of your pharmacy drug costs.
If you choose a Medicare Advantage Plan that includes drug coverage, your monthly plan premium will include the medical and drug portion of the plan.
Note: In some cases, your premium may be higher if you didn’t sign up for Part D when you first became eligible.
There are no cost breaks for married couples. Medicare requires each spouse to pay separate premiums, deductibles, copays, and coinsurance for prescription drug coverage. Each spouse will reach each level of coverage according to their own drug costs over each calendar year.
Find out how much your Cigna Healthcare Part D premium will be based on your location
How to Pay Your Part D Premium
There are 4 ways to pay your Medicare Part D Prescription Drug Plan premiums:
- You can have your premium automatically deducted from your savings or checking account, or charged to a credit or debit card.
- You can have the premium deducted from your Social Security benefit/check (if your monthly payment covers your premium).
- The insurer you choose for your plan(s) can send you a bill each month.
- Your employer (or prior employer) might pay your Medicare benefits, so you pay little to no premium.
Cigna Healthcare also offers the ability to pay your premiums online or over the phone.
Find out how you can pay your Cigna Healthcare Part D premium
Is there financial help for Part D?
Medicare provides assistance, known as Extra Help, in paying for prescription drug costs for those with limited income and resources.
If you qualify, you will receive help paying for any Medicare drug plan's monthly premium, annual deductible (if applicable), and prescription copays or coinsurance. This Extra Help will count towards your out-of-pocket expenses.
How do you choose a Medicare Part D plan?
The following factors may affect how you choose a Part D plan:
- Consider the medications you take—how many medications do you take, are they available as generics, do you have a chronic condition that requires specialty medications like insulin, nebulizers, etc.?
- If you want prescription drug coverage as part of a Medicare Advantage Plan, make sure you review the details of that drug coverage—is it enough to cover your prescription needs?
- Standalone plans can differ among private insurers and offer various levels of drug coverage and different pharmacy networks.
- Review Part D plan options, considering monthly premium and other costs.
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1 Most people will pay the standard monthly Medicare Prescription Drug Plan (Part D) premium. However, you may have to pay an extra amount because of your annual income. For 2023, single or married individuals filing separately whose income is $97,000 or above, and couples with an income of $183,000, will pay the extra amount.
If you are impacted, the Social Security Administration (not your Medicare Part D plan) will send you a letter telling you what the amount will be and how to pay it. This extra amount must be paid separately and cannot be paid with your monthly Part D premium.
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Medicare Advantage and Medicare Part D Policy Disclaimers
Cigna Healthcare products and services are provided exclusively by or through operating subsidiaries of The Cigna Group. The Cigna Healthcare names, logos, and marks, including THE CIGNA GROUP and CIGNA HEALTHCARE are owned by The Cigna Group Intellectual Property, Inc. Subsidiaries of The Cigna Group contract with Medicare to offer Medicare Advantage HMO and PPO plans and Part D Prescription Drug Plans (PDP) in select states, and with select State Medicaid programs. Enrollment in a Cigna Healthcare product depends on contract renewal.
To file a marketing complaint, contact Cigna Healthcare or call 1-800-MEDICARE (
Medicare Supplement Policy Disclaimers
Medicare Supplement website content not approved for use in: Oregon.
AN OUTLINE OF COVERAGE IS AVAILABLE UPON REQUEST. We'll provide an outline of coverage to all persons at the time the application is presented.
Our company and agents are not connected with or endorsed by the U.S. Government or the federal Medicare program. This is a solicitation for insurance. An insurance agent may contact you. Premium and benefits vary by plan selected. Plan availability varies by state. Medicare Supplement policies are underwritten by American Retirement Life Insurance Company, Cigna Health and Life Insurance Company, Cigna Insurance Company, Cigna National Health Insurance Company or Loyal American Life Insurance Company. Each insurer has sole responsibility for its own products.
The following Medicare Supplement Plans are available to persons eligible for Medicare due to disability: Plan A in Arkansas, Connecticut, Indiana, Maryland, Oklahoma, Rhode Island, Texas, and Virginia; Plans A, F, and G in North Carolina; and Plans C and D in New Jersey for individuals aged 50-64. Medicare Supplement policies contain exclusions, limitations, and terms under which the policies may be continued in force or discontinued. For costs and complete details of coverage, contact the company.
This website is designed as a marketing aid and is not to be construed as a contract for insurance. It provides a brief description of the important features of the policy. Please refer to the policy for the full terms and conditions of coverage.
In Kentucky, Plans A, F, G, HDG, N are available under Cigna National Health Insurance Company, Plans A, F, G, HDF, N are available under Cigna Health and Life Insurance Company and Plans A, B, C, D, F, G, N are available under Loyal American Life Insurance Company.
Kansas Disclosures, Exclusions and Limitations
Medicare Supplement Policy Forms: Plan A: CIC-MS-AA-A-KS, CIC-MS-AO-A-KS; Plan F: CIC-MS-AA-F-KS, CIC-MS-AO-F-KS; Plan G: CIC-MS-AA-G-KS, CIC-MS-AO-G-KS; Plan HDG: CIC-MS-AA-HDG-KS, CIC-MS-AO-HDG-KS; Plan N: CIC-MS-AA-N-KS, CIC-MS-AO-N-KS
Exclusions and Limitations:
The benefits of this policy will not duplicate any benefits paid by Medicare. The combined benefits of this policy and the benefits paid by Medicare may not exceed one hundred percent (100%) of the Medicare Eligible Expenses incurred. This policy will not pay benefits for the following:
(1) the Medicare Part B Deductible;
(2) any expense which You are not legally obligated to pay; or services for which no charge is normally made in the absence of insurance;
(3) any services that are not medically necessary as determined by Medicare;
(4) any portion of any expense for which payment is made by Medicare or other government programs (except Medicaid); or for which payment would have been made by Medicare if You were enrolled in Parts A and B of Medicare;
(5) any type of expense not a Medicare Eligible Expense except as provided previously in this policy;
(6) any deductible, Coinsurance or Co-payment not covered by Medicare, unless such coverage is listed as a benefit in this policy; or
(7) Preexisting Conditions: We will not pay for any expenses incurred for care or treatment of a Preexisting Condition for the first six (6) months from the effective date of coverage. This exclusion does not apply if You applied for and were issued this policy under guaranteed issue status; if on the date of application for this policy You had at least six (6) months of prior Creditable Coverage; or, if this policy is replacing another Medicare Supplement policy and a six (6) month waiting period has already been satisfied. Evidence of prior coverage or replacement must have been disclosed on the application for this policy. If You had less than six (6) months prior Creditable Coverage, the Preexisting Conditions limitation will be reduced by the aggregate amount of Creditable Coverage. If this policy is replacing another Medicare Supplement policy, credit will be given for any portion of the waiting period that has been satisfied.