Medicare Part D, sometimes referred to as a PDP (prescription drug plan), provides prescription drug coverage. Original Medicare alone does not provide prescription drug coverage. You’ll have to find prescription drug coverage in one of two different ways: either enroll in a PDP on top of your Original Medicare (Medicare Part A and Medicare Part B), or purchase a Medicare Advantage plan (Medicare Part C).

Prescription drug plans are commonly paired with Medicare Supplements.

If you do not enroll in some form of prescription drug coverage when you are eligible, you will be held liable for a late enrollment penalty fee.

Part D coverage is not the same for every plan. Each plan will have a formulary, which is a list of all the prescription drugs that it covers. The formulary will be divided into tiers according to cost level. Generally, tier one comprises of preferred (cheapest) generic drugs, and costs increase as you get to tier five, which usually includes speciality brand-name drugs.

If you choose to invest in a Medicare Advantage plan, your prescription drug premium will be included in your medical premium. If you choose to keep your Original Medicare and enroll in a separate prescription drug plan, you will have to pay a separate monthly premium. Unless you are eligible for LIS (low-income subsidies), you will be responsible for anything ranging from $13 to $80 per month depending on your income.

Big News!  The Donut hole is going away in 2025 and drug costs will be capped at $2,000.

Medicare recently announced the following.

• Beneficiary OOP spending is capped at $2,000 for 2025. 
• As in 2024, there is no beneficiary cost sharing above the annual OOP threshold in 2025. 
• The coverage gap phase (also known as the “donut hole”) will be eliminated, which will result in standard Part D coverage consisting of a three-phase benefit: a deductible phase, an initial coverage phase, and a catastrophic phase. There will be no initial coverage limit, and the initial coverage phase will extend to the maximum annual OOP threshold, at which point the catastrophic phase will begin. 

Just like Original Medicare, if you do not enroll in a Medicare prescription drug plan when you are eligible (disabled or 65), you will be responsible for a late enrollment penalty fee. If you need help enrolling, applying for low-income subsidies, or sorting through your options, you can set up a free appointment with one of our agents.

Our agents are licensed to sell from several different insurance companies, so there will be no bias in their assistance. Call to schedule your appointment at 520-760-6223.