Original Medicare (Parts A and B) does not cover most prescription drugs. Drug coverage comes from Medicare Part D, which is a separate plan you add on, or from a Medicare Advantage plan that includes drug coverage.
This is one of the most important things to understand early: original Medicare was designed long before prescription drug coverage was part of the picture. Parts A and B cover very few drugs, mainly ones given directly in a hospital or doctor's office, like infusions or injections administered during a medical visit.For the drugs you pick up at a pharmacy, you need Part D. Part D is a standalone prescription drug plan you add to Original Medicare. Alternatively, if you choose a Medicare Advantage plan (sometimes called Part C), most of those plans bundle drug coverage in.Every Part D plan has a formulary, which is simply a list of covered drugs. Plans group drugs into tiers, and your cost depends on which tier your medication falls into. Lower tiers usually mean lower costs, higher tiers can get expensive. Not every drug is on every plan's formulary, so checking that your specific medications are covered is one of the most important things you can do before enrolling.Starting in 2025, a significant change took effect: out-of-pocket costs for Part D drugs are capped at $2,000 per year. That's a meaningful protection for people on expensive medications. Premiums, deductibles, and formularies vary by plan and change annually, so comparing plans each fall during open enrollment can save real money.
Utah residents can compare Part D and Medicare Advantage drug plans available in their zip code at medicare.gov or get free personalized help through the Aging and Disability Resource Centers (ADRC), which is Utah's State Health Insurance Assistance Program (SHIP). Carriers like SelectHealth, Regence BlueCross, UHC, and others offer plans in Utah, and formularies differ between them.
For you, this means if you take regular prescriptions, you'll almost certainly want Part D or a Medicare Advantage plan with drug coverage, and checking that your specific medications are covered before you enroll is worth your time.
Our Commitment to Reliable Medicare Information
At Resting Sycamore Advisors, we work to provide accurate, current, and trustworthy information about Medicare Advantage, Medicare Part D, and Special Needs Plans.
To do that, we use data published by the Centers for Medicare & Medicaid Services (CMS), which is the official source for Medicare plan and enrollment information.
Our Medicare plan pages and comparison tools are powered by CMS datasets, including:
When possible, we link to the original CMS resources so you can review the source material directly.
We follow the CMS release schedule and update our website as new data becomes available.
We load new plan year Landscape and PBP files before the Medicare Annual Enrollment Period (October 15 through December 7). We also monitor CMS.gov for updates or revisions and refresh our content when needed.
We update enrollment and performance data as CMS publishes revised files, which are typically released monthly or quarterly.
We routinely monitor CMS announcements for corrections, reissued files, or other changes and update our pages accordingly.
Each plan page includes a Last Accessed date so visitors can see when the source information was most recently reviewed.
CMS data can be difficult to read in raw form. To make it easier to use, we format and organize the data for clarity.
This includes:
All data values come from CMS. We do not change the underlying values beyond formatting, organization, and presentation.
We keep internal records of the CMS dataset versions used on our site.
If CMS issues corrected or revised files, we update our website to reflect the latest available version.
Please keep the following in mind:
For personalized Medicare assistance, please use these official resources: