A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Speak with a licensed insurance agent 844-980-3459 TTY 711
Speak with a licensed insurance agent 844-980-3459 TTY 711
A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1999.
Featured
Miss open enrollment? You’ve got options.
Outside of the ACA's open enrollment period, you can only sign up for ACA-compliant health coverage if you qualify for a special enrollment period.
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Does health insurance cover drugs used for weight loss such as Ozempic, Wegovy, Mounjaro, and Zepbound?
Health insurance may cover drugs used for weight loss such as Ozempic, Wegovy, Mounjaro, and Zepbound if they’re prescribed for another medical condition, such as diabetes, but not if they’re being used specifically for weight loss.

Medicare Part D stand-alone prescription drug coverage

Infographic regarding Medicare Part D stand-alone prescription drug coverage

What is a Medicare Part D stand-alone prescription drug plan?

In most cases, stand-alone prescription drug coverage refers to Medicare Part D plans that Medicare beneficiaries purchase to supplement Original Medicare (or to supplement a Medicare Advantage Medicare Savings Account (MSA) plan or Private Fee-for-Service (PFFS) plan; most other Medicare Advantage plans include integrated Part D coverage). The plans are called "stand-alone" because they're purchased on their own, separate from the rest of the person's health coverage; it's common for an Original Medicare beneficiary to have a Part D plan from one insurer and a Medigap plan from a different insurer.

You might also hear someone refer to stand-alone prescription drug coverage for people who aren't enrolled in Medicare, although that's much less common. It's possible, however, to obtain stand-alone drug plans in the non-Medicare market, although they're usually prescription discount plans rather than insurance (here's an explanation of how that works).

Under the Affordable Care Act, all individual and small group health plans effective in 2014 or later include prescription drug coverage as an essential health benefit, so there's no need for a stand-alone drug plan if you have an ACA-compliant individual or small group plan (grandfathered and grandmothered plans can still exist without drug coverage). And although large group plans are not required to cover prescription drugs, nearly all of them do. States are not required to include prescription drug coverage in their Medicaid plans, but all of them currently do.

So Original Medicare is the only major type of health coverage that doesn't include prescription drug coverage, requiring enrollees to purchase supplemental stand-alone drug coverage. Medicare Part D is true insurance, but in most other cases, if people are buying stand-alone drug coverage, they may be getting a prescription discount program rather than an actual insurance plan.

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