Medicare Part D: Prescription Drugs

Original Medicare Parts A and B do not cover most prescription drugs. Medicare Part D is a standalone prescription drug plan you add to close this critical gap.

If you choose a Medicare Supplement (Medigap), you must enroll in a separate Part D plan to have prescription drug coverage.

What Is Medicare Part D?

Medicare Part D is optional prescription drug coverage offered by private insurance companies approved by Medicare.

Key Facts:

Voluntary but strongly recommended – You’ll face a late enrollment penalty if you delay and don’t have creditable coverage
Pairs with Medicare Supplement – Required if you have a Supplement plan
Usually included in Medicare Advantage – Most Advantage plans already include Part D
Varies by plan – Each plan has its own formulary (list of covered drugs), costs, and pharmacy networks

Part D Coverage Phases (2026)

Medicare Part D has different cost stages throughout the year:

1. Deductible Phase

You pay 100% of drug costs until you meet the plan’s deductible (varies by plan, up to $590 in 2026).

2. Initial Coverage Phase

After the deductible, you pay copays or coinsurance for each prescription based on the plan’s drug tiers.

3. Catastrophic Coverage

Once you reach $2,100 in out-of-pocket costs (2026), you pay very little for the rest of the year.

Important: If you take expensive medications (like cancer drugs, specialty biologics, or brand-name drugs), you may hit the $2,100 limit quickly. This is why we recommend Cancer or Critical Illness coverage for every Medicare beneficiary.

How We Help You Choose the Right Part D Plan

Part D plans vary dramatically. The lowest-premium plan is rarely the best choice for YOUR specific medications.

Our Simple Process:

1. Input Your Drugs
We use Medicare’s official Part D calculator and input your complete medication list.

2. Choose Your Pharmacy
We select your preferred pharmacy (or multiple pharmacies if needed).

3. Compare All Plans
We compare every Part D plan available in your zip code based on YOUR drugs and pharmacy.

4. Find the Lowest Total Cost
We identify the plan with the lowest total annual cost (premium + deductibles + copays) for YOUR specific situation.

5. Enroll
We handle the enrollment process and ensure your plan starts on time.

6. Re-evaluate Annually
Plans change every year. We review your coverage each Annual Election Period (Oct 15 – Dec 7) to make sure you’re still in the best plan.

Late Enrollment Penalty

If you don’t enroll in Part D when you’re first eligible and you don’t have other creditable prescription drug coverage, you’ll face a permanent late enrollment penalty.

The penalty:

1% of the national base premium for every month you were eligible but didn’t enroll
Added to your premium for as long as you have Medicare
Can add up to hundreds of dollars per year over time

Exception: If you have creditable coverage from an employer, union, TRICARE, or VA, you can delay Part D without penalty.

Part D Is Part of Your Medicare Umbrella

Part D prescription drug coverage is a critical layer of your Medicare Umbrella. But even with Part D, you can face high out-of-pocket costs if you take expensive medications.

Your Complete Medicare Umbrella:

Foundation Layer:

Medicare Supplement (or Medicare Advantage)
Part D Prescription Drug Plan

Protection Layer:

Cancer, Heart Attack & Stroke Coverage – If you’re diagnosed with cancer and need expensive drugs, you’ll hit the $2,100 Part D out-of-pocket limit fast. Critical illness coverage pays cash benefits to help cover these costs plus income replacement and non-medical expenses.

Protecting against the $2,100 out-of-pocket limit is why we recommend Cancer or Heart Attack/Stroke coverage for every Medicare beneficiary.

Annual Election Period (AEP): October 15 – December 7

Every year, you have the opportunity to switch your Part D plan or Medicare Advantage plan during the Annual Election Period.

Why this matters:

Plans change their formularies (drug lists) every year
Your medications may change
Premiums and copays change
A plan that was best for you last year may not be best this year

We provide FREE annual reviews to ensure you’re always in the best Part D plan for YOUR medications.

Ready to Find Your Best Part D Plan?

We’ll help you compare every Part D plan in your area based on YOUR specific medications and pharmacy, not generic recommendations.

If you’re turning 65 and are looking into your plan options, we recommend you schedule a call at no cost.
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Questions about Part D?

Call us at (951)404-0642 or schedule a free consultation to discuss your prescription drug coverage options.

For more information on Part D, visit Medicare.gov.