How to Enroll in Medicare Part D
A Complete Guide to Prescription Drug Coverage
Medicare Part D offers prescription drug coverage to help lower your medication costs. It’s available to everyone with Medicare, but you must actively enroll.
What is Medicare Part D?
Medicare Part D provides prescription drug coverage that helps pay for brand name and generic drugs at participating pharmacies nationwide. This coverage is voluntary but highly recommended. While Original Medicare (Parts A and B) covers many healthcare services, it doesn't include outpatient prescription drug coverage.
Medicare Part D Options
When it comes to getting Medicare drug coverage, you have two main options. Both are offered by private health insurance companies approved by Medicare:
1. Standalone Prescription Drug Plan (PDP)
- Covers only prescription drugs – you’ll still need separate coverage for hospital and medical services
- Ideal if you have Original Medicare (Part A and B)
- A smart choice if you're happy with your current doctors but need drug benefits
2. Medicare Advantage Plan with Prescription Drug Coverage (MAPD)
- Combines hospital (Part A), medical (Part B), and drug (Part D) coverage in one convenient plan
- Often includes extra benefits like dental, vision, hearing, or fitness programs
- One plan, one card – makes managing your healthcare simple
- Many MAPD plans offer $0 premiums and low copays for generic medications
Can I Have a PDP and MAPD at the Same Time?
No, you cannot be enrolled in both a standalone Prescription Drug Plan (PDP) and a Medicare Advantage Prescription Drug Plan (MAPD) at the same time. These plans are offered by different health insurance companies and are not designed to work together.
If you enroll in an MAPD while currently in a PDP, your PDP coverage will be automatically canceled when the new MAPD plan becomes active. Always review your plan’s drug coverage before switching to avoid any coverage gaps.
How to Enroll in Medicare Part D
You can enroll in a Medicare Part D drug plan in one of the following ways:
- Online: Use the Medicare Plan Finder and start by entering your zip code
- By Phone: Call Medicare at 1-800-MEDICARE (1-800-633-4227) or TTY 1-877-486-2048
- Directly Through a Medicare Advantage Health Plan: Visit the health plan’s website to learn how to enroll directly
- Through a Licensed Broker: Work with a licensed insurance broker who can help you compare plans and guide you through the enrollment process
Alignment Health Plan offers MAPD plans with built-in drug coverage and additional health benefits. Search for plans offered in your area by entering your ZIP code in our online Plan Finder.
When to Enroll in Medicare Part D
Enrollment is time-sensitive. You can enroll in or make changes to your Medicare Part D prescription drug plan during:
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- Starts 3 months before your 65th birthday
- Ends 3 months after your birthday month
- Missing this window may result in a late enrollment penalty
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- October 15 – December 7 each year
- Coverage changes take effect January 1
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- January 1 – March 31 each year
- Only available if you're already enrolled in Original Medicare (Part A and B) or a Medicare Advantage plan (Part C)
Medicare Part D Benefits
Medicare Part D benefits will vary by plan, but most deliver comprehensive benefits that are designed to make your prescriptions more affordable and convenient. Key benefits typically include:
- Comprehensive drug coverage: Covers both generic and brand name medications
- National pharmacy networks: Fill prescriptions locally or through convenient mail order
- Tiered drug pricing: Lower copays for generics, higher for specialty drugs
- No or low deductibles: Many plans begin coverage immediately
- Convenient tools: Many plans offer mobile apps or online portals to easily manage prescriptions and refills
- Extra savings programs: Some plans provide discounts or savings for certain drug tiers or mail-order services
Plans from providers like Alignment Health Plan go above and beyond, offering health-focused extras like 24/7 live support, wellness rewards, and personalized care coordination.
How Much Does Medicare Part D Cost?
Costs for Medicare Part D vary by plan and may include:
- Monthly Premiums: Varies by plan; some MAPDs offer $0 premiums
- Annual Deductible: In 2026, this can be up to $615, depending on the plan
- Copays/Coinsurance: You pay a portion of the cost for each prescription, often based on a tiered pricing system
- Coverage Gap ("Donut Hole"): The traditional "donut hole" coverage gap has been eliminated as of 2025, making prescription drug coverage more predictable and affordable
- Catastrophic Coverage: For 2026, once your out-of-pocket spending reaches $2,100, you’ll enter catastrophic coverage and pay nothing for covered prescription drugs for the rest of the year, providing significant financial protection against high drug costs
TIP: Always review your plan’s drug formulary and pricing tiers to understand your total cost.
Choosing the Right Plan
To find a plan that works for you, consider:
- Are your current prescriptions covered? (Check the plan’s drug formulary)
- Are low premiums or generic drug copays important to you?
What If My Medication Isn't Covered?
If you discover a medication you need isn't on your plan's covered drug list (also known as the drug formulary), you have several options to get the coverage you need:
- Request a formulary exception: Ask your plan to cover a non-formulary drug if it's medically necessary
- Try a covered alternative: Work with your doctor to find a similar medication that's on your plan's formulary
- Appeal coverage decisions: If your plan denies coverage, you have the right to appeal their decision
- Get temporary coverage: Most plans provide emergency prescription refills while exceptions are being processed
TIP: Keep your doctor involved in these conversations. They can provide the medical documentation needed to support coverage requests and help you explore the best alternatives for your health needs.
Frequently Asked Questions (FAQ) about Medicare Part D Prescription Drug Coverage
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A Medicare Part D isn't free, but it's designed to be affordable. You'll pay a monthly premium that varies depending on which plan you choose. The good news is that many plans, including Medicare Advantage plans, offer great value with comprehensive prescription coverage.
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A While it's optional, you don't want to delay enrollment. If you don't sign up when you’re first eligible and decide to enroll later, you may face a late enrollment penalty, unless you've had other creditable prescription drug coverage. We recommend enrolling to avoid unexpected prescription drug costs.
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A You may have to pay a permanent late enrollment penalty added to your monthly premium.
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A Absolutely. You can make changes to your coverage during Annual Enrollment Period (AEP) from October 15 to December 7, Open Enrollment Period (OEP) from January 1 to March 31, or if you qualify for a Special Enrollment Period (SEP).
Explore Your Medicare Part D Options Today
Whether you want standalone prescription drug plan or an all-in-one Medicare Advantage plan with prescription drug coverage, you have options. At Alignment Health Plan, we're here to help you understand your options every step of the way and enroll with confidence.
Give us a call at 1-888-293-8272 (TTY: 711) to learn more about your Medicare prescription coverage options and to find the plan that's right for you. We are available from 8:00 a.m. to 8:00 p.m., 7 days a week (except Thanksgiving and Christmas) from October 1 through March 31 and Monday to Friday (except holidays) from April 1 through September 30.
You can also explore your options here at Alignment Health Plan with our online Plan Finder tool or register to attend a seminar to see which Medicare Advantage plans are available in your area.