How to Choose a Medicare Part D Plan

Access to prescription drugs is a critical part of healthcare in retirement. Learn how to choose a Medicare Part D plan for 2025!

How to Choose a Medicare Part D Plan for 2025

According to data from the Commonwealth Fund, prescription drug costs account for about 20% of all medical costs in retirement.

So without some sort of plan to tackle prescription drug costs, you have a big, gaping hole in your insurance coverage during your golden years.

That’s why it’s important to ensure you are enrolled in the right Medicare Part D prescription drug plan: A plan that you can afford, which covers the drugs that you will actually need in retirement.

This blog post will walk you through what Medicare Part D is, how it interfaces with Medicare Advantage and Medigap plans, and how to choose the best plan for your individual needs.

What is Medicare Part D and Why Do You Need It?

Medicare Part D is the prescription drug component of Medicare.

Original Medicare (Parts A and B) don’t include prescription drug coverage.

Most Medicare beneficiaries need some form of prescription drug coverage. However, Original Medicare (Parts A and B) don’t include it at all.

Neither do Medigap plans.

If you have a Medicare Advantage (Part C) plan, it may come with its own built-in prescription drug coverage. If it doesn’t, you should consider purchasing a separate, standalone Part D plan.

But how do you choose which one is best for you?

Not all Part D prescription drug plans are alike. Knowing your options will help you make the best decisions for your health and your wallet.

Do You Need a Standalone Plan?

First, you should decide whether you need a standalone Medicare Part D prescription drug (PDP), or get your drug coverage via a Medicare Advantage Drug Plan, or MA-PD.

If you are enrolled in or plan to enroll in Medigap, you need a standalone plan. You also need a standalone plan if you enroll in the Medi-Share 65+ healthsharing plan. Neither Medigap nor Medi-Share 65+ includes prescription drug coverage on their own.

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How To Compare Part D Plans

Pricing

Of course, pricing is important.

But you should consider more than just monthly premiums. It’s important to review the plan’s entire cost structure. Especially if you take a lot of prescription drugs.

So on top of premiums, you should also consider

Covered Drugs

You should also carefully inspect each plan’s formulary, or list of covered drugs. 

For each drug you take or anticipate taking, check the pricing tier. Tier 1 drugs are inexpensive and typically generic equivalents. Some classes of drugs are automatically covered in all Medicare Part D Plans.

Tier 4 drugs can potentially cost thousands of dollars per month, or even per dose without insurance.

You can expect higher out-of-pocket costs for these drugs than for Tier 1 drugs/generics. 

Exclusions

Although Medicare Part D covers a large array of medications, some types of drugs are typically not covered. 

For example, drugs not approved by the FDA or drugs used for cosmetic purposes are rarely covered by Medicare. 

Pharmacy Network

Select a local pharmacy that accepts Medicare Part D Plans.

Most pharmacies across the United States accept Medicare Part D plans, but it’s a good idea to check with your preferred pharmacy to ensure they’re in-network with your chosen plan.

Using in-network pharmacies typically results in lower out-of-pocket costs.

Financial Assistance for Part D Plans

Extra Help

If you have a limited income, you may qualify for Extra Help, a federal program that assists with Medicare Part D costs.

You can apply for Extra Help through the Social Security Administration or your state’s Medicaid office.

State Assistance Programs

 Some states offer State Pharmaceutical Assistance Programs (SPAPs) that can help lower-income Medicare beneficiaries cover their prescription drug costs.

These programs vary by state, so check with your local Medicare office for details.

What To Do Now

Click here to request a quote for a great Medicare Part D prescription drug plan.

Your Personal Benefits Advisor will go over your medical needs and budget and help you choose a Part D plan or Medicare Advantage plan with prescription drug benefits that fits your needs. 

When Should You Enroll in Part D?

If you are new to Medicare, the best time to enroll in Medicare Part D  is during your Medicare Initial Enrollment Period (IEP).

Your IEP typically begins three months before the month in which you turn 65, and ends at the end of the third month after the month in which you turn 65.

So all told, you’ll have about seven months of open enrollment to decide on and enroll in a plan.

The other best time to enroll in a Part D plan is during AEP, the open enrollment period that runs from October 15th to December 7th. 

Beware of Part D Late Enrollment Penalties

If you fail to enroll in Part D during your IEP, and you don’t have other prescription drug coverage in force, you will have to pay late enrollment penalties.

The penalty is calculated based on the number of months you were without coverage, and it’s added to your premium for as long as you have a Part D plan.

So the longer you wait to enroll in Part D, the bigger the penalty. And the penalty will last the rest of your life, as long as you have a Part D plan. 

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Conclusion

Choosing the right Medicare Part D plan is a decision that can significantly impact your healthcare expenses and access to prescription medications.

The best way to start is to take a look at your priorities and healthcare needs. Utilize the tools listed above to inform yourself so you can make the choice that best meets your needs.  Remember to review your plan annually during the Annual Enrollment Period to ensure it still aligns with your requirements and preferences.

Here are some additional blogs for further reading: How to Avoid this Costly Medicare Mistake | What Kind of Medicare Plan Is Best for Me? (Quiz) | What’s New in Medicare for 2024? | What is the “Maximum Out-of-Pocket” in Medicare Plans? | Why You Should Use an Independent Agent to Buy Your Medicare Plan | What Are Medicare Excess Charges?

Here are some additional pages related to this article: Medi-Share 65+ | Medicare Part D Prescription Drug Coverage