What is Medicare Part D?

Medicare Prescription Drug Plans (Medicare Part D) are prescription drug plans offered through private insurance companies approved by Medicare. They are designed to help you pay for the cost of your medications, both brand-name and generic, and work alongside your Original Medicare, Medicare Supplement plan, or certain Medicare Advantage plans.

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Part D plans are optional, but if you don’t enroll when you’re first eligible and don’t have other credible prescription drug coverage, you may have to pay a late enrollment penalty if you join later. Each Part D plan has its own list of covered drugs (called a formulary), and costs can vary depending on the plan you choose, the medications you take, and the pharmacy you use.

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Most Part D plans have three cost stages: the deductible stage, where you pay 100% of your drug costs until the deductible is met; the initial coverage stage, where you share costs with your plan; and catastrophic coverage.

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Whether you take a few medications or manage a more complex condition, Medicare Part D can help lower your prescription costs and protect you from high drug expenses in the future. We’re here to help you compare plans and find the coverage that fits your needs.

What Drugs are Covered Under Medicare Part D?

Medicare Prescription Drug Plans cover all vaccines recommended to prevent illness, including important ones like flu and shingles shots. Beyond vaccines, each plan has its own formulary—a list of covered medications—that can vary from one plan to another. This formulary outlines exactly which drugs are covered and how much they’ll cost you. That is why it is important to work with a licensed Medicare agent, like those at Mountaineer Health and Life Insurance, to understand which of your drugs are covered and what your estimated costs may be. 

What Drugs Are Not Covered By Medicare Part D?

While Medicare Part D covers a wide range of prescription medications, there are certain types of drugs that are excluded by law and generally not covered by any Part D plan. Knowing what isn’t covered can help you avoid surprises and better plan for your healthcare expenses.

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Here are the most common types of drugs not covered under Medicare Part D:

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• Over-the-counter (OTC) medications – Drugs you can buy without a prescription, like aspirin, cold medicine, or antacids, are not covered, even if prescribed by a doctor.

• Drugs for weight loss or weight gain – Medications used to treat obesity or promote weight gain are typically excluded, unless they're prescribed for a different medical condition and approved by the plan.

• Fertility drugs – Medications to help with fertility or reproduction are not covered.

• Cosmetic or lifestyle drugs – This includes drugs used for hair growth, erectile dysfunction, or other cosmetic purposes.

• Vitamins and minerals – Most vitamins and supplements are not covered under Part D, unless they are specifically listed as a covered prescription-strength formulation (like prenatal vitamins or prescription folic acid).

• Drugs for anorexia or appetite stimulation – These are generally excluded unless used to treat a specific medical condition like cancer or AIDS-related weight loss.

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It’s also important to remember that not every drug within a covered category is included in every plan’s formulary. If your specific medication isn’t covered, there may be an alternative that is—or you may be able to request an exception.

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If you’re unsure whether your medications are covered under Part D, we’re here to help you review your options and find a plan that fits your needs.

Why You Should Review Your Medicare Part D Plan Each Year

Even if you’re happy with your current Medicare Part D plan, it’s important to review it every year during the Annual Enrollment Period (October 15 – December 7). That’s because Part D plans can—and often do—change from year to year. What worked for you this year may not be your best option next year.

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Here’s why an annual review matters:

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• Drug Formularies Can Change: Your plan’s list of covered drugs might not include all the same medications next year. A medication you rely on could be removed or moved to a higher-cost tier, affecting your out-of-pocket costs.

• Pharmacy Networks May Shift: Plans often change which pharmacies are considered “preferred,” which can impact how much you pay at the counter. A pharmacy that offered the lowest prices this year might not offer the same savings next year.

• Costs Can Go Up (or Down): Monthly premiums, deductibles, and copays can all change from year to year. Reviewing your plan ensures you’re not paying more than you need to.

• Your Health Needs May Have Changed: If you’ve been prescribed new medications or had changes in your health, your current plan may no longer be the best fit. A review helps make sure your coverage still aligns with your needs.

• New Plans Become Available: Each year, new plans may enter the market—some with better coverage, lower premiums, or more generous benefits. You could be missing out on a better value if you don't explore your options.

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Working with a licensed Medicare agent to review your Part D plan each year takes the guesswork out of the process. We’ll help you compare plans, review any changes, and make sure you’re getting the coverage that best fits your needs—so you’re always one step ahead.

Let Us Help at No Cost!

We’re here to walk you through the process step by step, answer your questions along the way, and help you understand all of your options in a way that actually makes sense. Our goal is to make things simple, clear, and stress-free—so you can feel confident about the choices you’re making.

Call Us: 304-989-5809

Email: info@mountaineerhealthandlife.com