Medicare Part D – Prescription Drug Coverage
Prescription drug costs can add up fast — and without the right coverage, they can be unpredictable. Medicare Part D is designed to help keep your medications affordable and your costs predictable all year long.
I’m Jake McGeoy, your local Medicare Part D agent. My goal is to help you choose a Part D plan that fits your prescriptions, your budget, and your peace of mind—without any surprises at the pharmacy.
What Does Part D Cover?
Every Part D plan comes with a formulary (a list of covered medications). These lists are organized into tiers, which impact how much you’ll pay for each drug. Most plans cover:
- Generic and brand-name drugs
- Medications for chronic conditions like diabetes, high blood pressure, and asthma
- Specialty medications for complex conditions
- Certain vaccines (like shingles and Tdap), often at no cost
Drug Tiers Explained:
- Tier 1: Preferred generics – lowest cost
- Tier 2: Generics – slightly higher cost
- Tier 3: Preferred brand-name drugs – moderate cost
- Tier 4: Non-preferred brand-name drugs – higher cost
- Tier 5: Specialty drugs – highest cost
How Part D Coverage Works (4 Stages)
- Deductible Stage – You pay full cost for certain drugs until your deductible is met.
- Initial Coverage – You pay copays/coinsurance; your plan covers the rest.
- Coverage Gap (“Donut Hole”) – Once total drug costs hit a set limit, you pay up to 25% for covered drugs.
- Catastrophic Coverage – You pay nothing for covered drugs for the rest of the year.
Why You Shouldn’t Skip Part D If you delay enrolling in Part D when you’re first eligible, you could face a late enrollment penalty that lasts as long as you have Medicare. Even if you don’t take many prescriptions now, a low-cost plan can protect you from unexpected high drug costs later.
Costs & Coverage at a Glance
| Feature | What It Means | Your Cost (2025) |
|---|---|---|
| Monthly Premium | Paid to your plan; varies by company & location. | $0 – $60+ |
| Annual Deductible | Amount you pay before coverage starts (not all tiers require it). | Up to $545 |
| Copays / Coinsurance | Your share of the prescription cost. | Varies by tier |
| Catastrophic Coverage | After hitting your yearly out-of-pocket limit, you pay $0. | $0 |