Medicare Part D — Prescription Drug Coverage

Original Medicare doesn't cover most prescription drugs. Part D fills that gap. Compare plans based on your specific medications — not just the premium.

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What Is Medicare Part D?

Medicare Part D is prescription drug coverage offered through private insurance companies approved by Medicare. It's available as a standalone Prescription Drug Plan (PDP) — added to Original Medicare or a Medicare Supplement plan — or bundled into most Medicare Advantage plans (MAPD).

Each Part D plan has a formulary — a list of covered drugs organized into tiers. Lower tiers (generics) have lower copays; higher tiers (brand-name, specialty drugs) cost more. The formulary, premiums, and cost-sharing change every year.

The most important thing when choosing a Part D plan is not the premium — it's whether your specific medications are covered, and at what tier. William runs a formulary comparison for every client before recommending a plan.

How Part D Coverage Works

Deductible Phase

You pay 100% of drug costs until you meet the annual deductible (varies by plan; CMS sets a maximum each year). Not all plans charge a deductible.

Initial Coverage Phase

You pay your plan's copays or coinsurance. The plan pays the rest until your total out-of-pocket drug costs reach the annual cap set by CMS.

Catastrophic Coverage Phase

After reaching the out-of-pocket cap, you pay a small copay or coinsurance for the rest of the year. The "donut hole" coverage gap was eliminated starting in 2025.

Starting in 2025: The "donut hole" (coverage gap) has been eliminated. After reaching the annual out-of-pocket cap, you enter catastrophic coverage with minimal cost-sharing for the rest of the year.

What You Need to Know

Avoid the Late Enrollment Penalty

If you don't enroll in Part D when you're first eligible and don't have other creditable drug coverage, you'll pay a permanent penalty added to your premium for every month you were without coverage.

Check Your Formulary Every Year

Drug formularies change annually. A medication covered this year may be on a higher tier — or removed entirely — next year. Review your plan every fall during AEP (Oct 15 – Dec 7).

Enrollment Periods Matter

Initial Enrollment Period: 7-month window around your 65th birthday. Annual Enrollment Period: Oct 15 – Dec 7 each year. Special Enrollment Periods available for qualifying life events.

Ready to enroll in Part D?

How to sign up for Part D on Medicare.gov

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"I contacted William to assist my wife and I after moving to Florida from another state. He contacted us immediately and scheduled a phone appointment for the following week. We spent about an hour getting to know each other and our needs. He recommended several companies to match our needs and our location here in FL that we would NEVER had figured out on our own. Praise the Lord for Bill and for his help!! I would recommend him to anyone and everyone!!"

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