Medicare Part D, the Medicare Prescription Drug Benefit, is a federal government program offering prescription drug coverage to people eligible for Medicare. Unlike Parts A & B, Medicare Part D was not part of the original Medicare law that became effective in 1965. Part D is part of the Medicare Modernization Act of 2003 that went into effect on January 1, 2006. 

So, what is covered and how does it work? 


Medicare Part D can be confusing. Here is some information to help the medicine go down! Unlike Parts A&B and most Medicare Supplement plans, Part D premium costs, deductibles and drug costs can vary from carrier-to-carrier. First, some definitions

Carrier/Plan Provider: an insurance company offering coverage. In Texas, several carriers offer Part D coverage, with many plans and options to choose from. 

Formulary: a carrier’s list of the drugs it covers. Each plan has its own list of covered drugs, which carriers generally put on their websites. You can enter your medication in the carrier’s online formulary to see if they cover your drug. 

Tiers: Many carriers place drugs into different “tiers” on their formularies, with drugs in lower tiers generally costing less. Most plans have four tiers: 1) Preferred Generics; 2) Preferred Brands; 3) Non-preferred Brands and Generics; 4) Specialty Drugs.

Medicare Part D Q&A 

Medicare Part D has many ins-and-outs. No wonder we are getting lots of questions. The answers to common questions will make Plan D easier to understand:

Q: What does Plan D cover? 

A: Medicare Part D covers only out-patient prescription drugs. Drugs administered in the hospital are covered by Part A. To enroll in Part D you must be enrolled in Medicare Part A and  Part B. Medicare Part D premiums are additional to Part A and/or Part B premiums.

Q: When do I first become eligible? 

A: The initial six-month enrollment window is three months before and three months after your 65th birthday. So if your birthday is September 10, your first enrollment period is June 10 to December 10. You have four ways to enroll: 1) visit; 2) Fill out the plan provider’s enrollment form; 3) Call the plan provider; 4) Call 1.800.MEDICARE (1.800.633.4227). If you miss the six-month window, there is a premium penalty, which is calculated according to how long you waited. For more information, check with Medicare or your plan provider. Best practice: Sign up within your six-month window! 

Q: After my initial enrollment, can I renew or change providers at any time? 

A: You can only change plans once a year during Plan D Open Enrollment, which for 2017 is Oct. 15 to Dec. 7. If you decide to change plans and/or carriers, your new coverage begins January 1. 


Stateside Insurance Services, since 2003, has focused on providing comprehensive health insurance information, responsive customer service and expert industry knowledge for Texas consumers.  Stateside has annually been recognized by health insurance carriers and the Health Insurance Marketplace as a Top Producer in Texas.

Whether the health insurance policy is for an individual, family, small business or supplemental Medicare coverage, Stateside dedicates the time, and our deep industry expertise, to ensure our clients have identified the best health insurance plan for their specific needs. 

Stateside is available to answer any general questions regarding your coverage options, can provide a subsidy determination, and even assist in creating and submitting online applications for ACA compliant plans during an Open Enrollment or throughout Special Enrollment periods. 

Stateside can be contacted either by phone (866) 444-3332 (toll free) or by email at Our Telephone Appointment System can be accessed through:

Phone Appointment Reservation.  

By using the Telephone Appointment System, clients can take advantage of scheduling a health insurance discussion when convenient for their schedule. During Open Enrollment phone appointment availability is expanded to include extended hours and weekends.