You can get drug coverage with a standalone Part D plan or as part of a Medicare Advantage plan (Part C).
Some plans have pharmacy networks and mail order pharmacies that offer discounted prices.
Plans are offered by private insurance companies approved by Medicare. Your choices vary depending on where you live. Coverage and costs beyond the standards set by Medicare vary from plan to plan.
You must be enrolled in Part A or Part B to be eligible for a Part D plan.
Deductible in 2024
Overview of Changes to the Part D Benefit:
In 2025, the structure of the Part D benefit is updated to reflect the provisions of the Inflation Reduction Act that become effective on January 1, 2025.
Medicare Part D plans cover:
- Types of drugs most commonly prescribed according to federal standards
- Specific brand name and generic drugs on the plan formulary, or list of drugs
- Commercially available vaccines not covered by Part B
Coverage stages
A newly defined standard Part D benefit design consisting of three phases:
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Annual deductible up to $590
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Initial coverage
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Removal of the Coverage Gap phase
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Catastrophic coverage: which has a lower annual out-of-pocket (OOP) threshold of $2,000
Premium
- Plan premiums vary widely and can change from year to year.
- You may pay a premium penalty if you are late to enroll in Part D.
- Many Part C plans include drug coverage.
Deductible
- The maximum deductible in 2020 is $590.
- Not all plans have a deductible.
- Plans may apply separate deductibles for drugs in different tiers.
Copay
- Plans may charge copays for prescriptions and refills. Amounts vary.
Coinsurance
- Some plans may set coinsurance rates for certain drugs or drug tiers.
- In 2020, you pay 25% of the cost for both brand name and generic drugs.
