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Prescription Drug Coverage

Lower Your Medication Costs

Part D helps cover the cost of your prescription medications. We compare every plan available in your area to find the one that covers your drugs at the lowest total cost.

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Understanding Part D

What Is Medicare Part D?

The Medicare benefit that helps pay for your outpatient prescription medications.

Medicare Part D covers outpatient prescription medications — the drugs you pick up at a pharmacy or receive through mail order. It is available to everyone enrolled in Original Medicare (Parts A and B).

Part D comes in two forms: a standalone Prescription Drug Plan (PDP) that works alongside Original Medicare and a Medigap supplement, or bundled into a Medicare Advantage plan (MAPD) that includes drug coverage as part of the plan.

Part D is technically optional, but it is strongly recommended. If you delay enrollment past your Initial Enrollment Period without other creditable drug coverage, you will face a late enrollment penalty that lasts for as long as you have Part D.

Key point: Even if you take no medications now, enroll in Part D when first eligible. Skipping it creates a lifetime penalty that grows every month you go without coverage.

Two Ways to Get Part D

Standalone PDP paired with Original Medicare, or bundled into a Medicare Advantage plan (MAPD). Either way, we compare every option in your area to find the best fit for your medications.

WE COMPARE EVERY PLAN FOR YOU

Give us your drug list and pharmacy preference. We run every plan in your zip code and show you which one covers your medications at the lowest annual cost — including premiums, deductibles, and copays.

Drug Formularies

Understanding Drug Formularies & Tiers

Every Part D plan has a formulary — a list of covered drugs. The same medication can cost very different amounts depending on the plan.

Tier 1
Preferred Generic
Lowest-cost drugs on the plan. These are commonly used generic medications that the plan has negotiated the best pricing on. Expect the smallest copays here.
Tier 2
Generic
Other generic medications covered by the plan. Still affordable, but may cost slightly more than Tier 1 preferred generics.
Tier 3
Preferred Brand
Brand-name drugs that the plan has placed on its preferred list. Costs more than generics, but the plan has negotiated better pricing than non-preferred brands.
Tier 4
Non-Preferred Brand
Brand-name medications not on the preferred list. Higher copays or coinsurance. A different plan may cover the same drug at a lower tier.
Tier 5
Specialty
High-cost medications for complex conditions. These often require prior authorization and have the highest out-of-pocket costs. Plan comparison is critical here.
Important: The same drug can sit on different tiers across different plans. A medication that costs you $45 on one plan might cost $10 on another. This is exactly why running your drug list through a plan comparison before choosing is essential — and it is something we do for you at no cost.

Coverage Phases

How Part D Coverage Phases Work

Your out-of-pocket costs change as you move through the coverage phases during the year. Starting in 2025, the structure was significantly simplified with a hard annual out-of-pocket cap.

1

Deductible Phase

You pay the full cost of your drugs until you meet the plan’s annual deductible. Not all plans have a deductible — some start covering drugs from day one. The maximum allowable deductible is set by Medicare each year.

2

Initial Coverage

After the deductible, you pay a copay or coinsurance for each prescription and your plan pays the rest. This is where formulary tiers matter most — lower-tier drugs have smaller copays.

3

Catastrophic Coverage

Once your total out-of-pocket drug spending reaches the annual cap, you pay $0 for covered drugs for the rest of the year. No more copays, no more coinsurance.

2026 Cap: The annual out-of-pocket cap is now $2,100 — and the old “donut hole” coverage gap has been eliminated.

Starting in 2025, Medicare eliminated the coverage gap (“donut hole”) and introduced a hard $2,000 annual cap on out-of-pocket drug spending. For 2026, that cap increased to $2,100. This simplification benefits all Part D enrollees.

Late Enrollment Penalty

Avoiding the Part D Late Enrollment Penalty

Delaying Part D enrollment without creditable coverage triggers a permanent penalty added to your monthly premium.

If you go 63 or more consecutive days without Part D or other creditable prescription drug coverage after your Initial Enrollment Period ends, you will pay a late enrollment penalty when you do eventually enroll.

The penalty is calculated as 1% of the national base beneficiary premium for each full month you were without creditable coverage. This amount is added to your Part D premium every month — and it never goes away.

Example: If you went 24 months without coverage, your penalty would be 24% of the national base premium, added to your monthly Part D premium permanently. Over time, this can add up to thousands of dollars in extra costs.

The penalty is recalculated each year as the national base premium changes, so the dollar amount can increase even though the percentage stays the same.

Exceptions — Creditable Coverage

  • Employer or union prescription drug coverage that is considered creditable
  • TRICARE (military retiree drug coverage)
  • Veterans Affairs (VA) prescription benefits
  • Federal Employee Health Benefits (FEHB) program
  • Indian Health Service or tribal coverage
Pro tip: If you have creditable coverage from an employer or other source, keep your “creditable coverage notice” — the letter your plan sends each year confirming your drug coverage meets Medicare’s standards. You will need this proof if you enroll in Part D later to avoid the penalty.

Simple Process

How We Help You Find the Right Plan

Three steps to lower prescription costs — and it costs you nothing.

1

Free Consultation

Call or schedule a meeting with Jesse or Arnie. Share your current medications, preferred pharmacy, and any concerns about your current plan — no pressure, no obligation.

2

We Compare Plans

We run your drug list through every Part D plan available in your zip code. You see a side-by-side comparison of total annual costs — premiums, deductibles, and copays combined.

3

Enroll & Relax

We handle all the enrollment paperwork. Your new plan takes effect, and we check in each year during Annual Enrollment to make sure your plan still covers your drugs at the best price.

Common Questions

Part D FAQ

Do I need Part D if I don’t take any medications?

Yes, it is strongly recommended. If you delay enrollment and don’t have other creditable drug coverage, you will face a late enrollment penalty — a permanent surcharge added to your Part D premium for as long as you have coverage. Even if you are healthy now, enrolling when first eligible protects you from this penalty and ensures you have coverage if your needs change.

How do I know if my drugs are covered by a plan?

Every Part D plan publishes a formulary — a list of all drugs the plan covers and what tier each drug is on. We run your specific medications through every available plan in your area so you can see exactly which plans cover your drugs and what they will cost. This comparison is free and takes just a few minutes.

What is the Part D late enrollment penalty?

The penalty is 1% of the national base beneficiary premium for each full month you went without creditable prescription drug coverage after your Initial Enrollment Period. This percentage is added to your monthly Part D premium permanently. For example, going 30 months without coverage means a 30% penalty added to your premium every month for the rest of your life.

Can I change my Part D plan every year?

Yes. During the Annual Enrollment Period (October 15 through December 7 each year), you can switch to a different Part D plan. This is important because plan formularies, premiums, and copays change every year — a plan that was the best deal last year may not be this year. We review your plan annually at no cost to make sure you are still on the best option.

What is creditable coverage?

Creditable coverage is prescription drug coverage from another source (employer plan, union plan, TRICARE, VA, FEHB, etc.) that is expected to pay, on average, at least as much as Medicare’s standard Part D coverage. If you have creditable coverage, you can delay Part D enrollment without penalty. Your plan is required to send you a notice each year telling you whether your coverage is creditable — keep that letter.

Find the Part D Plan That Covers Your Medications

Share your drug list with us and we will show you which plan in your area offers the lowest total cost — completely free.

Compare Part D Plans — Free Call 1-855-937-4600