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What Is Medicare Part D?

Medicare Part D is prescription drug coverage offered by private insurance companies approved by Medicare. It helps cover the cost of your prescription medications.

Key Facts:

• Part D is optional, but there’s a penalty if you delay enrollment without other creditable drug coverage
• Plans vary in which drugs they cover (formulary), costs, and which pharmacies you can use
• You can get Part D as a standalone plan (if you have Original Medicare + Medigap) or built into a Medicare Advantage plan
• Plans change every year — your best plan this year might not be your best plan next year

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How Part D Works

The Four Coverage Stages

Most Part D plans have four cost stages each year:

Stage 1: Deductible
You pay full price for drugs until you meet your plan’s deductible (up to $590 in 2026).

Stage 2: Initial Coverage
You pay copays or coinsurance for your drugs. The plan pays its share.

Stage 3: Coverage Gap (“Donut Hole”)
After you and your plan have spent a combined amount on drugs, you enter the coverage gap. As of 2025, the Inflation Reduction Act has capped out-of-pocket costs, significantly reducing donut hole exposure.

Stage 4: Catastrophic Coverage
After your out-of-pocket spending reaches the annual cap ($2,000 in 2025+), you pay nothing for the rest of the year.

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How to Compare Part D Plans

Choosing the right Part D plan depends entirely on YOUR specific medications. Here’s what matters:

What to Compare

1. Formulary — Is each of your medications on the plan’s drug list?
2. Tier Placement — What tier is each drug on? (Lower tier = lower cost)
3. Pharmacy Network — Are your preferred pharmacies in-network?
4. Monthly Premium — How much is the plan per month?
5. Annual Drug Costs — What’s the total estimated cost for YOUR drugs for the year?
6. Mail-Order Options — Can you save with 90-day mail-order prescriptions?

Why You Need Help Comparing

There are dozens of Part D plans available in Central Florida, each with different formularies and costs. The difference between the cheapest and most expensive option for YOUR medications can be hundreds or even thousands of dollars per year.

Joel will input your complete medication list and compare every available plan to find your lowest total annual cost.

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Enrollment Periods

Period	Dates	Notes
Initial Enrollment Period (IEP)	3 months before to 3 months after turning 65	First chance to enroll
Annual Enrollment Period (AEP)	October 15 – December 7	Change plans for the following year
Open Enrollment Period (OEP)	January 1 – March 31	Switch MA plans (includes drug coverage)
Special Enrollment Period (SEP)	Varies	Qualifying life events

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Why Review Your Plan Every Year?

Part D plans change annually:

• Formularies change — your drug might move to a higher tier or be dropped
• Premiums change — what was cheap last year might not be this year
• Pharmacies change — your pharmacy might leave the network
• Your medications change — new prescriptions mean a different best plan

Joel reviews your plan every year during AEP to make sure you’re still on the best option. It’s free, and it could save you hundreds.

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