Medicare Part D Prescription Drug Coverage

What is Medicare Part D?

Which drugs are covered under Medicare Part D?

The specific list of prescription drugs covered by your Part D plan (known as the formulary) will vary depending on both the provider and plan options. However, all plan formularies are required to include at least two chemically distinct drugs in each of these six pharmacological categories:

Additionally, except for a few doctor-administered vaccines covered under Medicare Part B, Part D plans must include all medically necessary vaccinations needed to prevent disease.

Part D plans can and do include other drugs over and above the minimum required in each category. But every Part D plan is different.

Formularies typically don’t include all possible drugs within any one category. So your specific prescribed drug may not be on your plan’s formulary. Usually, however, the plan will include a clinically effective alternative. 

If you or your physician or other prescriber believes that none of the plan’s covered drugs will be effective for you, you can apply for an exception.

NEW INSULIN BENEFIT: Covered insulin products are now capped at $35 for a one month supply. You do not have to cover a deductible to get this benefit.

If you choose a 60- or 90-day insulin supply, the cost cannot exceed the equivalent of $35 per month.

Questions? Your MediGap Advisors Personal Benefits Manager can help you find a plan that includes the drugs you need. You can join or switch a Medicare Part D plan during the Fall Enrollment Period, which runs from October 7th through December 15th every year.

Make an appointment with a Personal Benefits Manager.

New in 2025! The Medicare Prescription Payment Plan

Starting in 2025, you have the option to spread your out-of-pocket prescription drug costs over the course of the plan year rather than all up front to the pharmacy. You can pay nothing to the pharmacy, and your Part D plan will bill you for the monthly payments. 

How do I enroll in Medicare Part D?

There are two options for obtaining a Medicare Part D plan:

Medicare Advantage plans are available through a number of different companies and include numerous plan options.

Don’t go it alone: Work with one of our expert MediGap Advisors Personal Benefits Managers for free personalized help in finding and enrolling in the plan that best meets your individual needs.

It costs nothing extra. And we can save you hours of research into individual plan formularies and other documents.

How much does Medicare Part D cost?

Like other healthcare plans, the cost of Part D premiums, deductibles, and copayments can change from year to year. In addition, your premium will vary depending on which plan you choose, your location, and your income.

For some low-income Medicare enrollees, the Extra Help program can provide a subsidy that pays for a portion of your Part D premium.  Find out if you qualify for Extra Help.

Medicare Part D 2025 cost:

Paying your Medicare Part D monthly premiums

When paying the monthly premium, you have the option to have the payment automatically deducted from your Social Security check.

The insurance company you choose can arrange this payment method. You can also choose to have the premiums automatically deducted from a checking account, or pay through the mail.

When to Sign-up for Medicare Part D Coverage – Enrollment Periods

You can enroll for Part D Prescription Drug Coverage when you become eligible at age 65, or during the open enrollment period.

1. Annual Enrollment Election Period

The Annual Enrollment Election Period runs from October 15 through December 7 of every year. During this time, you may enroll in or change Medicare Prescription Drug Plans under the following qualifications:

• • You are entitled to Medicare Part A or are enrolled in Part B.
  • Your permanent residence is within the United States. You must continue to pay your Medicare Part B Premium, if not otherwise paid for under Medicaid or by another third party.
  • You are not enrolled or do not plan to stay enrolled in another Medicare Prescription Drug Plan.
  • You may enroll in only one Medicare Prescription Drug Plan at a time and may not be enrolled in a Medicare Advantage Plan at the same time. If you choose a Medicare Advantage Plan, your prescription drug coverage is included.

If you currently have a Medicare Supplement plan, you can also switch to a different plan during the Annual Enrollment Election Period

2. Initial Enrollment Period

The Initial Enrollment Period is a seven-month period that includes the month during which you first become eligible (at age 65 or earlier if you qualify due to a disability or end-stage renal disease) plus the three months before and the three months after the month in which you become eligible.

If you do not enroll during your seven-month Initial Enrollment period, you will have an opportunity to join a prescription drug plan every year from October 15 through December.

However, if you enroll after the Initial Period you will be assessed a late enrollment penalty.

The late penalty is currently 1% of the national average monthly premium for each month you were eligible but were not enrolled in a Medicare Prescription Drug Plan. The penalty will be added to your premium for as long as you are enrolled in Medicare’s prescription drug coverage.

You can delay enrollment in Medicare’s prescription drug coverage without paying a penalty if you have prior creditable coverage on an individual policy or through an employer group policy. Creditable coverage means you have a drug benefit that equals (or is better than) Medicare’s standard prescription drug coverage.

3. Special Enrollment Period

A Special Enrollment Period is available in certain situations, such as if you become disabled or move outside of the service area your plan provides. In these cases, you may enroll in or change Medicare Prescription Drug Plans at any time.

Save Money on Your Prescriptions

Since there is a late-enrollment penalty for delaying the purchase of a PDP, you may benefit from signing up for a Part D plan even if you are not currently on any medications.  In this way, you can choose the least expensive plan in order to avoid the penalty, with the option of switching to a more comprehensive plan if your needs change.

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