Follow us on Twitter



Medicare Part D North Carolina

Medicare Part D North Carolina coverage is what you will need to enroll in for prescription drugs. These plans are commonly referred to as PDP's (Prescription Drug Plans) and are administered by Medicare approved private insurance companies for typically a nominal monthly premium.  These premiums can range from as low as $15/mo up to around $113/mo.  A PDP can be purchased seperately or could be incorporated in your NC Medicare Advantage Plan.

If you are enrolled in Medicare you are eligible for a PDP.  If you are turning 65, your window of opportunity to enroll will be the same as Part B, which is 3 months before, month of, and 3 months after your 65th birthday. After this initial enrollment period the only other time to enroll will be the annual election period which is October 15 - December 7.

Should you pay for this coverage if you're turning 65 and you don't take any prescription drugs? If you elect NOT to enroll in a PDP when first eligible and then decide to enroll later when you need it you will be assessed a penaly.  This penalty is equivalant to 1% of the average cost of a PDP for each month you are not enrolled.  This 1% can add up and will carry with you as long as you stay on a Part D plan.  Our advise for this situation would be to enroll in the least expensive plan option.  If you needed to change for better coverage later you would then be able to do this during the Annual Enrollment Period.

How to Choose the Right Medicare Part D Plan in North Carolina?

All plans offered by carriers have different formularies (drugs that are covered by each plan).  Therefore, the plan that is right for you may not be right for your husband due to the different formularies.  The Medicare website is fairly easy to navigate and will allow you to enter all your prescription drugs and will identify the least expensive plan options for you based on your current medications.  For our clients that purchase a NC Medicare supplement using our services we will do this for you as an added service.

How do These Plans Work?

It really depends on the plan you choose. Most will have copays for generic and brand drugs while others may pay as a percentage.  Some plans may have a deductible (up to $320 for 2012) before the plan would start paying.  You will pay these copays and/or percentages until you reached the "donut hole".

What is the Donut Hole?

Most Medicare approved PDP plans have a coverage gap, known as the donut hole, in which there is a temporary limit on what the plan will pay for the drugs. While in the coverage gap you get a 50% manufacturer-paid discount on covered brand drugs.  In addition you will pay 86% for covered generic drugs while in the gap. Some plans offer additional assistance in the gap, this is just what is mandated by Medicare.

Catastrophic Coverage

Once you have reached the maximium on your plans donut hole you are then covered under catastrophic coverage which will limit your cost exposure to a small copay or percentage. This keeps your costs from spiraling out of control.


As you can see there is a lot of confusing information about Part D.  If you are interested in purchasing a NC Medicare Supplement we will assist you with your Medicare Part D North Carolina options. We do not sell these plans to you, only make recommendations; therefore we can only assist our valued customers with this.