Medicare Prescription Drug Plans (Part D):

Coverage for Your Medications

Standalone prescription drug coverage that works with Original Medicare.

What are Medicare Prescription Drug Plans?

Medicare Prescription Drug Plans, also known as Part D plans, provide coverage for prescription medications for Medicare beneficiaries. These standalone plans work alongside Original Medicare (Parts A and B) to help cover the cost of both brand-name and generic prescription drugs.

Part D plans are offered by private insurance companies approved by Medicare. Each plan has its own list of covered drugs (called a formulary), network of pharmacies, and cost structure. This allows you to choose a plan that best meets your medication needs and budget.

If you have Original Medicare and want prescription drug coverage, enrolling in a Part D plan is essential. Without this coverage, you might pay full price for your medications, which can be costly. Additionally, if you don't enroll when you're first eligible and don't have other creditable prescription drug coverage, you may face a late enrollment penalty if you decide to join later.

Shop For Plans

How Medicare Part D Works

Understanding how Medicare Part D works can help you make informed decisions about your prescription drug coverage and manage your medication costs effectively.

Formularies

Each Part D plan has a list of covered drugs called a formulary. Plans categorize drugs into different "tiers," with drugs in lower tiers generally costing less than those in higher tiers. Formularies can change, but your plan must notify you when necessary.

Pharmacy Networks

Part D plans contract with pharmacies to provide covered drugs at negotiated prices. Using in-network pharmacies typically results in lower out-of-pocket costs. Some plans also offer preferred pharmacies where your costs may be even lower.

Coverage Phases

Medicare Part D has four coverage phases that affect what you pay for your medications throughout the year:

1. Deductible Stage:

You pay 100% of your drug costs until you reach your deductible.

The standard deductible for Part D plans in 2025 is $590, but some plans have lower or zero deductibles.

2. Initial Coverage Stage:

After you meet your deductible, you'll pay a portion of your drug costs.

You'll typically pay a copay or coinsurance, depending on the drug tier.

Out-of-pocket costs in this stage are capped at $2,000 for 2025.

3. Catastrophic Coverage Stage:

Once you reach $2,000 in out-of-pocket costs, you enter catastrophic coverage.

You pay nothing for covered drugs for the rest of the year.

Note: Dollar amounts are for the 2025 benefit year and may change annually.

Medicare Part D costs can vary significantly from plan to plan. Understanding these costs can help you budget for your prescription drug expenses and choose a plan that offers the best value for your needs.

Premium

Most Part D plans charge a monthly premium that you pay in addition to your Part B premium. Premiums vary by plan and can change each year. If your modified adjusted gross income is above a certain amount, you may also pay an income-related monthly adjustment amount (IRMAA) in addition to your plan premium.

Annual Deductible

This is the amount you pay for your prescriptions before your plan begins to pay its share. Deductibles vary by plan, and some plans don't have a deductible. The maximum deductible allowed for Part D plans in 2025 is $545.

Copayments and Coinsurance

After you meet your deductible, you pay either a copayment (a fixed dollar amount) or coinsurance (a percentage of the drug's cost) for each prescription. These amounts vary by plan and by drug tier.

Extra Help Program

If you have limited income and resources, you may qualify for Extra Help (also called the Low-Income Subsidy or LIS), a Medicare program that helps pay for Part D premiums, deductibles, and copayments.

Late Enrollment Penalty

If you go without Part D or other creditable prescription drug coverage for 63 days or more after your Initial Enrollment Period ends, you may have to pay a late enrollment penalty if you join a Part D plan later. The penalty is calculated by multiplying 1% of the "national base beneficiary premium" ($34.70 in 2025) by the number of full months you were eligible for Part D but didn't join and didn't have creditable coverage. This amount is added to your monthly premium for as long as you have Part D.

Book An Appointment

How to Choose the Right Part D Plan

With numerous Part D plans available, choosing the right one requires careful consideration of your medication needs and budget. Here are some factors to consider:

Medication Coverage

• Are all your current medications covered in the plan's formulary?

• What tier are your medications in, and what are the associated costs?

• Are there any restrictions (prior authorization, quantity limits, step therapy)?

Pharmacy Network

• Are your preferred pharmacies in the plan's network?

• Does the plan offer mail-order pharmacy services?

• Are there preferred pharmacies where you can save on copayments?

Costs

• What is the monthly premium?

• Is there a deductible, and if so, how much is it?

• What are the copayments or coinsurance for your specific medications?

• How do costs change in the coverage gap and catastrophic coverage phases?

Star Ratings

Medicare assigns star ratings to plans based on quality and performance. Plans with higher ratings (4-5 stars) generally provide better service and member satisfaction.

Plan Stability

• How long has the plan been available in your area?

• Has the plan maintained consistent formulary coverage and costs over time?

Finding the right Medicare Part D plan can be complex, but you don't have to navigate this process alone. Our licensed value-added consultants at C & K Healthcare Advisors can help you compare plans, understand formularies, and make an informed decision about your prescription drug coverage.

Shop For Plans

Book An Appointment

Annual Medicare Drug Coverage Review

Even if you're satisfied with your current Part D plan, it's important to review your coverage annually. Plans can change their costs, formularies, and pharmacy networks each year, and your medication needs may also change over time.

During the Annual Enrollment Period (October 15 - December 7), take time to:

Review any changes to your current plan for the upcoming year
Check if all your medications are still covered
Compare your current plan with other available options
Consider any changes in your health or prescription needs

Follow Us On:

Get In Touch

Assistance Hours:

Mon–Fri 8:00am – 5:00pm EST

Saturday & Sunday – By Appointment Only

Email:
[email protected]

Phone Number:

(888) 869-7270

Required Disclaimers

This is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/co-insurance may change on January 1 of each year. Medicare has neither reviewed nor endorsed this information.

C & K Healthcare Advisors is not connected with or endorsed by the United States government or the federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

By contacting us, you may be speaking with a licensed insurance agent who may sell Medicare plans on behalf of contracted insurance companies. This Website serves as an educational invitation for you, the customer, to inquire about further information regarding your health insurance options, and submission of your contact information constitutes as permission for a Licensed Insurance Representative to contact you with further information, including complete details on cost and coverage of this insurance. Contact will be made by a licensed insurance agent/producer or insurance company. This is a solicitation for Insurance .C & K Healthcare Advisors, LLC and their agents are licensed and certified representatives of a Health and Life Insurance organization. Enrollment in any plan depends on contract renewal.

Nothing on this website should ever be used as a substitute for professional medical advice.