Prescription Drug Plans (Part D)

How Do Prescription Drug Plans Work?

Medicare Part D is your prescription drug coverage. Part D coverage is available as a Stand Alone Option (PDP) or as part of a Medicare Advantage plan (Part C). Part D plans are offered by private insurance companies contracted and approved by Medicare.

If, after your first chance to enroll, you go 63 days or more in a row without Part D or other creditable drug coverage, you may owe a late enrollment penalty on top of your Part D premium, and you generally pay it for as long as you have Part D.

Here is important information you need to know about owning a prescription drug plan:

Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but Medicare sets the most a plan can charge, and that limit changes every year. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you begin initial coverage.

Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copay amount for which you are responsible. It is typically separated by generic drugs, preferred name brands, even more specialized medications, and so on. This stage covers costs up to a yearly limit before moving to the next stage.

The Old Coverage Gap — Since 2025, Part D has a yearly cap on what you pay out of pocket for covered drugs, and the old coverage gap stage (the “donut hole”) no longer applies. Ask us for this year’s exact numbers.

Catastrophic Coverage — Once your out-of-pocket spending reaches that yearly cap, your plan covers your formulary drugs for the remainder of the year.

Medicare resets these amounts every year. Matt will walk you through this year’s numbers for the medications you actually take.

Same medications, different plans, different costs. That is why the formulary matters.

How would I enroll?

Fill out the form and we will be in contact soon or call us today at 810-432-0525.