Medicare Part D

Prescription Drug Plans

2024 Part D Overview & Stages

2025 Part D Plan Changes

How Drugs are priced...

Prescription Discount Companies

Prescription Drug Plans in Medicare…

Part D Prescription Drug Plans are offered through a variety of insurance companies on a standalone basis or they can be included in your Medicare Advantage plan. There are a number of standalone plans as well as Medicare Advantage plans with Part D coverage available in each state. Your most appropriate solution depends on the medications you anticipate filling and the pharmacy you prefer to shop.

Plans vary based on:

- Monthly premium
- Formulary List (which prescriptions they cover)
- Tier assignments for each covered medication
- Copay amounts during initial coverage stage
- Network pharmacies

Prescription Drug Plan Phases in 2024

Every Medicare Prescription Drug Plan (PDP) will have 4 stages of coverage depending on how high your medication costs may become during the year. Regardless of if you purchase a Standalone PDP Plan or you have a PDP coverage through your Medicare Advantage Plan, you will have 4 stages of coverage.

Prescription Drug Plan Phases in 2025

One of the key component’s to the Inflation Reduction act is the removal of the Donut Hole/Coverage Gap. In 2025 Part D plans will only have 3 Phases.

Part D High Income Surcharge- IRMAA

If you earn more than the base income tier, you will receive an income surcharge on your Medicare Part D Prescription Plan. This surcharge will be billed directly by Social Security with your Part B premium (if you are collecting Social Security Income, this amount is automatically withdrawn from your Social security check once you enroll in a Part D Plan.

Medicare Premiums by Income

Do I need a Prescription Plan if I don’t take Prescriptions?

Although you are not required to enroll in a Part D Prescription plan, there are two main issues with not enrolling: Penalties and Deadlines

More on Deadlines & Penalties
Part D Penalty: You will receive a Part D Late Enrollment Penalty if you do not have creditable prescription coverage after age 65.

Creditable prescription coverage is drug coverage that is expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

A 1% penalty added for every 1 month you go without creditable prescription coverage. Months need not be consecutive.

The penalty will be assessed on the Average Medicare Part D Premium for as long as you are enrolled in Medicare Part D.

Part D Deadlines: If you do not enroll in a Part D within 3 months of your Part A effective date or within 63 days of coming off of creditable prescription coverage, you can only enroll in a plan once a year during the Annual Enrollment period. The Annual Enrollment Period (AEP) which is from Oct 15^th – Dec 7^th every year. During this time, you are able to enroll in a Prescription Drug Plan which will go into effect on January 1^st. You may not enroll in a Prescription Drug Plan outside of the Annual Enrollment Period unless you qualify due to specific special exceptions.

Example: If you suddenly need drug coverage due to a health event and it’s outside of your enrollment period, you will need to wait until the AEP to enroll in a plan. The plan will not go into effect until the following January, potentially leaving you without coverage.

Please see Medicare.gov for on eligible enrollment periods for Part D.

Can I use outside discount drug programs (like GoodRx) with my Part D Plan?

You can use either your Part D plan or a drug discount card for medications, but not both for the same prescription. Check the price on the discount program’s website before going to the pharmacy. If your Part D plan price is higher, ask to use the discount program instead. Keep in mind that Medicare plans may have deductibles, so your initial costs could be high but may drop after meeting the deductible. However, paying outside your plan won’t count toward your deductible, so sometimes it makes sense to pay more under the plan to meet it.