Part D Prescription Drug Plans
You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday, or if you are under 65 and eligible for Medicare.
It's important to do this on time because there may be a permanent premium surcharge for enrolling after your initial enrollment period if you don't have equivalent drug coverage from another source, such as a retiree plan.
Let us help you with your enrollment
If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the Annual Enrollment Period (AEP), which runs from Oct. 15 to Dec. 7 every year.
Making Part D work
Your out-of-pocket spending on covered drugs will be capped at $2,100 in 2026. This means that once you reach $2,100 in prescription expenses, you will not have additional out-of-pocket costs for the remainder of the year. This cap is aimed at helping individuals manage high prescription costs throughout the year.
The deductible is rising slightly to $615 for many plans, although this may vary depending on individual plan details.
Part D drug benefits in 2025 are structured into three phases:
- Annual deductible. If your plan has a deductible, you will pay 100% of your gross covered prescription drug costs until the annual deductible is met.
- Initial coverage. Once the annual deductible is met, you will pay 25% coinsurance for covered Part D drugs. This phase ends when you have reached the annual out-of-pocket cap of $2,100 for 2026.
- Catastrophic. Once you meet the $2100 out-of-pocket cap, you will pay no cost sharing for covered Part D drugs.
These updates aim to make Part D costs more predictable and manageable, especially for those with high-cost medications. The changes are part of the broader Inflation Reduction Act adjustments, which bring greater financial relief to Medicare enrollees in need of costly prescriptions.
Choosing a plan
It pays to review your Part D coverage every year, especially if you have started taking new drugs.
- Start at Medicare.gov, where you can find the basics about the benefit and Part D plans. There's a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs and the network status of their contracted pharmacies. When comparing plans, be sure to sort plans by "lowest drug + premium cost". Sometimes a plan with a higher monthly premium is actually more cost effective than a plan with a lower premium due to differences in formularies or plan designs.
Call us to help you understand your options.
Getting financial help
Individuals with 2025 annual incomes of less than $23,475 and financial resources of up to $17,600 or married couples with incomes of less than $31,725 and financial resources of up to $35,130 might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
See Medicare's instructions on applying for the Extra Help program.
Additionally, read about the ways to lower your drug costs on Medicare.gov.
This information was obtained from www.medicare.gov
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