Medicare Part D – Drug Coverage

Part D is coverage offered by private insurance companies to for prescription drugs. Of all the parts of Medicare (A, B, C, and D), this is the part that causes the most headaches. In this article, we breakdown exactly how Medicare Part D works for Medicare beneficiaries.

How Part D Coverage Works

There are 2 different ways to get your Medicare Part D coverage:

#1 ) Stand-alone Prescription Drug Plans (PDP)

A stand-alone drug plan is typically chosen to go along with a Medicare Supplement plan (which aren’t able to cover drugs). Your PDP will have its own card that you show at the pharmacy and you’ll have a monthly premium to be on the plan. Then your prescriptions will each have a co-pay depending on what Tier they are.

#2 ) Medicare Advantage Prescription Drug Plans (MAPD)

Prescription drug coverage can also be built into Medicare Advantage plans. You’ll continue to have co-pays just like you would if you had a stand-alone plan, but often times you can find a MAPD that doesn’t have a premium.

Important!

If you go without creditable prescription drug coverage, you'll have a lifetime penalty added on each month if you ever decide to enroll in Part D in the future.

Part D Coverage Levels

Every Part D plan has 4 levels of coverage. You move from one level to another based on your drug expenses for the year.

Deductible – You pay the full amount of your medications until you reach the plan’s yearly deductible.
- For 2024, the maximum deductible is set at $545. Depending on the plan, your deductible may be less and may not apply to generic medications.
Initial Coverage – You pay a co-pay or co-insurance for your medication depending on which “tier” it is.
- Preferred Generics (Tier 1) cost less than Brand Name (Tier 4), which cost less than Specialty Drugs (Tier 5).
Coverage Gap – You pay 25% of the cost of your medication.
- Related: Learn more about the Part D Donut Hole
Catastrophic Coverage – Once you’ve paid $8,000 out-of-pocket on your Prescription Drugs for the year, you switch to the Catastophic Coverage phase where you no longer have any cost-sharing for the rest of the year.
- You’ll remain in this coverage level until January 1st when you reset back into the deductible.

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Costs for Medicare Part D

The national average for a Part D drug plan is $34.70, with some available at much lower costs and others much higher.

Picking the right drug plan is extremely dependent on the list of medications that you take. The highest price plan per month might have very low co-pays for your medications, while the cheapest plan might not cover them at all.

If you don’t take any medications, you’re likely better off with one of the cheaper plans. Consider your total out-of-pocket costs when selecting a Part D plan, not just the monthly premiums.

Medicare Part D Drug Plans