PRIMARY CARE CLINIC
Medicare can be confusing—especially when it comes to prescription drug coverage. That’s where Medicare Part D comes in.
At Temecula Medical Group, we want to help you understand your options so you can get the medications you need without surprises. In this post, we’re breaking down Medicare Part D, what it covers, and how it works with your overall care.
Medicare Part D helps cover the cost of prescription drugs. It’s offered by private insurance companies that are approved by Medicare, and you can get it in one of two ways:
As a stand-alone prescription drug plan (PDP) — used with Original Medicare
As part of a Medicare Advantage plan (Part C) that includes drug coverage
You are not automatically enrolled in Part D—you must sign up for it separately if you need it.
Each Part D plan has its own formulary—a list of covered medications. The formulary is organized into tiers, with lower-tier drugs (like generics) costing less than higher-tier brand-name or specialty medications.
Most Part D plans cover:
Generic and brand-name drugs
Common maintenance medications (for conditions like high blood pressure, diabetes, or high cholesterol)
Vaccines like shingles and Tdap (flu and COVID-19 vaccines are covered under Part B)
Tip from Temecula Medical Group: Always review your plan’s formulary to make sure your medications are covered—and ask our team if you need help.
Your costs under Medicare Part D may include:
A monthly premium (varies by plan)
An annual deductible
Copays or coinsurance based on the drug tier
A coverage gap (also known as the “donut hole”)—though this has been reduced significantly in recent years
Each year, you’ll also have an out-of-pocket maximum after which you pay only a small coinsurance or copay for medications.
Part D does not cover:
Over-the-counter medications
Medications not listed on your plan’s formulary
Drugs covered under Part B (like those administered in a doctor's office)
Even if you don’t take many prescriptions now, enrolling in a Part D plan when you're first eligible helps you avoid late enrollment penalties later on.
Plus, having the right drug coverage can save you money and make it easier to manage chronic conditions over time.
If you’re unsure which plan is right for you or you need help reviewing your medication list, just give us a call.
We can:
Coordinate care with your pharmacy
Help you get prior authorizations when needed
Recommend generic or cost-effective alternatives
Assist with medication management and education
Call us at (951) 302-2526 or stop by Temecula Medical Group—we're happy to help you get the most out of your Medicare benefits.
