You can sign up for Medicare Part D Prescription Drug Plans, which help cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday. It’s important to enroll in a Prescription Drug Plan on time because there’s a permanent premium surcharge for enrolling more than three months after your 65th birthday if you don’t have equivalent drug coverage from another source, such as a retiree plan.
Let me help you with your enrollment!
If you’re new to Medicare, or if you are already enrolled in a Part D “standalone” plan or a Medicare Advantage plan that incorporates drug coverage call now for a free annual evaluation.
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Making Medicare Part D Prescription Drug Plans Work.
NEW! Starting in 2025, your out-of-pocket drug costs will be capped at $2,000.
Your actual drug coverage costs will vary depending on:
• Your prescriptions and whether they’re on your plan’s list of covered drugs (formulary).
• What “tier” a drug is in.
•Which drug benefit phase you’re in (like whether you’ve met your deductible, or reached your out-of-pocket limit).
• Which pharmacy you use (whether it offers preferred or standard cost sharing, is out of network, or is mail order). Your out-of-pocket drug costs may be less at a preferred pharmacy because it has agreed with your plan to charge less.
• Whether you get Extra Help paying your Medicare drug costs
NEW! Medicare Prescription Payment Plan Starting in 2025
This new payment option works with your current drug coverage to help you manage your out-of-pocket drug costs, by spreading them across the calendar year (January–December). This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs. If you select this payment option, each month you’ll continue to pay your plan premium (if you have one), and you’ll get a bill from your health or drug plan to pay for your prescription drugs (instead of paying the pharmacy). All plans offer this payment option, and participation is voluntary. It doesn’t cost anything to participate in the Medicare Prescription Payment Plan.
Monthly Premiums
Most drug plans charge a monthly fee that varies by plan. If you have Part B, you pay this in addition to the Part B premium. If you’re in a Medicare Advantage Plan or a Medicare Cost Plan with drug coverage, the monthly premium may include an amount for drug coverage.
Important! If you have a higher income, you might pay more for your Medicare drug coverage (Part D). If your income is above a certain limit (in 2024 $103,000 if you file individually or $206,000 if you’re married and file jointly), you’ll pay an extra amount in addition to your plan premium (sometimes called “Part D IRMAA”). You’ll also have to pay this extra amount if you’re in a Medicare Advantage Plan that includes drug coverage. This doesn’t affect everyone, so most people won’t pay an extra amount.
Yearly Deductible
This is the amount you must pay before your plan begins to pay its share of your covered drugs. Some plans don’t have a deductible. In some plans that do have a deductible, drugs on some tiers are covered before the deductible.
Copayments or Coinsurance
These are the amounts you pay for your covered drugs after the deductible (if the plan has one). You pay your share and your plan pays its share for covered drugs. If you pay coinsurance, these amounts may vary because drug plans and manufacturers can change what they charge at any time throughout the year. The amount you pay will also depend on the tier level assigned to your drug.
INSULIN
Your Medicare drug plan can’t charge you more than $35 for a one-month supply of each Part D-covered insulin, and you don’t have to pay a deductible. You’ll pay $35 (or less) for a one-month supply of each Part D-covered insulin product, even if you get Extra Help to lower your prescription drug costs
Choosing a Plan.
It pays to review your Medicare Part D Prescription Drug plan’s coverage every year, especially if you have started taking new drugs.
- Start at Medicare Insurance Direct 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. It will even show you your monthly out-of-pocket drug cost for the year.
Getting Financial Assistance.
In 2025, individuals with annual incomes in 2024 of less than $22,590 per year and financial resources of up to $17,220, or married couples with incomes of less than $30,660 and financial resources of up to $34,360, might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.
Download Medicare’s instructions on applying for the Extra Help program.
Additionally, read about the six ways to lower your drug costs on Medicare.gov.
This information was obtained from www.medicare.gov
