What is a PDP (Prescription Drug Plan)?

Published by Medicare Made Clear®

Medicare Part D prescription drug plans are also known as PDPs. These are standalone plans that can be purchased through private insurance companies. PDPs provide coverage for prescription drugs and medications and may also cover some vaccines too.

Original Medicare (Parts A & B) doesn't provide prescription drug coverage. If you have Original Medicare and need prescription drug coverage, you’ll want to sign up for a Part D prescription drug plan.

What does a PDP cover?

Plans will vary by location and provider in terms of costs and specific drugs covered. Each plan will have a list of specific drugs it covers, known as a formulary, but all PDPs are required by law to cover certain common types of drugs.

Medicare Part D plans are required to cover the Shingles vaccine, but they may also cover other vaccines such as Tdap, for the flu and pneumonia. What vaccines are covered outside of Shingles will depend on your plan. You can learn more about Medicare and vaccine coverage from the Center for Medicaid and Medicare Services (CMS) and by talking directly with the plan’s provider.

Enrolling in a Part D Prescription Drug Plan

To get a PDP plan, you will have to enroll directly with the plan provider. Unless you qualify for a Special Enrollment Period due to working past 65, it’s best to enroll in Part D when you’re first eligible for Medicare. This will be during your Initial Enrollment Period.

If you do not enroll in Part D when first eligible and do not qualify for a Special Enrollment Period, you could face financial penalties. You can learn about financial penalties in this blog.

Can I combine a PDP plan with other Medicare coverage?

Yes, you can combine Medicare coverage parts with a Part D plan. A stand-alone PDP can work with Original Medicare (Parts A & B) and certain types of Medicare Advantage plans such as Medicare Medical Savings Account plans without drug coverage or Private Fee-for-Service plans.

You can have a stand-alone prescription drug plan with certain types of Medicare Advantage plans so long as the plan:

  • Can’t offer coverage for prescription drugs
  • Chooses not to offer coverage for prescription drugs

If after the first time you enroll you decide to change your PDP, you can do so each year during the Medicare Annual Enrollment Period, which begins October 15 and ends December 7.

Part D prescription drug coverage is important to ensuring you can get all the medications you need to live your healthiest life.

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