PRESCRIPTION DRUG COVERAGE
Medicare Part D Drug Plans
We analyze your specific medications against every available plan to find your lowest total annual drug cost, not just the lowest premium.
PRESCRIPTION DRUG COVERAGE
The Right Drug Plan
Saves You Real Money
Medicare Part D provides prescription drug coverage through private insurance plans approved and regulated by Medicare. Choosing the wrong Part D plan is one of the most common and costly Medicare mistakes people make; often costing hundreds or thousands of dollars more per year for the exact same medications.
The reason is the formulary, every plan has its own list of covered drugs, placed on different cost tiers. A drug that costs you $10/month on one plan might cost $80/month on another. Without comparing your specific drugs against every available plan, you're essentially guessing.
Do You Need a Standalone Part D Plan?
It depends on how you have your Medicare coverage set up:
Medigap Plans Are Standardized By Law
⟶ If you have Original Medicare + Medigap: You need a standalone Part D plan. Medigap does not include drug coverage.
⟶ If you have Medicare Advantage: Most MA plans include Part D drug coverage built in. You generally do not need and cannot have a separate Part D plan.
⟶ If you have employer coverage: You may be able to delay Part D enrollment without penalty if your employer plan meets Medicare's "creditable coverage" standard. We verify this for every client.
How Part D Plans Work
Formularies and Drug Tiers
Every Part D plan maintains a formulary, a list of covered prescription drugs. Each drug on the formulary is placed on a cost tier, with higher tiers meaning higher out-of-pocket costs. Most plans have 5 tiers: generic drugs (lowest cost), preferred brand, non-preferred brand, specialty drugs (highest cost), and sometimes a select care tier for the lowest-cost generics.
The Coverage Phases
Part D coverage works in phases that reset each January 1:
Medigap Plan Comparison at a Glance
⟶ Deductible Phase: You pay 100% of drug costs until you meet your deductible (up to $615 in 2026, some plans have $0 deductible for preferred drugs).
⟶ Initial Coverage Phase: You pay your copay or coinsurance; the plan pays the rest
⟶ Catastrophic Coverage: After reaching $2,100 in out-of-pocket costs in 2026, you pay nothing for covered drugs for the rest of the year.
The Late Enrollment Penalty — Don't Miss Your Window
This is critically important: if you don't enroll in Part D when you're first eligible and you don't have other creditable drug coverage, you'll pay a permanent late enrollment penalty for as long as you have Medicare drug coverage. The penalty is 1% of the national base premium for every month you were without coverage and it never goes away.
Example: The Cost of Waiting
If you go 24 months without creditable drug coverage, your penalty is 24% of the base premium, added permanently to every Part D premium you ever pay. On a $40/month plan, that's an extra $9.60 every single month for the rest of your life. We make sure every client understands their enrollment window and acts within it.
Our Part D Analysis Process
Finding the right Part D plan isn't about the lowest premium; it's about the lowest total annual cost, which includes your premium, deductible, and actual drug costs based on your specific medications and the dosages you take.
⟶ Step 1: You provide your complete medication list with dosages and preferred pharmacy
⟶ Step 2: We run your drugs through every available Part D plan in Ohio
⟶ Step 3: We calculate your total estimated annual cost — premium + deductible + drug costs — for each plan
⟶ Step 4: We present you with the top options clearly, with no pressure
⟶ Step 5: We review every year during Annual Enrollment, formularies and drug prices change annually
Extra Help — Low Income Subsidy
If your income and resources are below certain limits, you may qualify for Extra Help; a federal program that significantly reduces your Part D costs, including premiums, deductibles, and copayments. We check every client's potential eligibility for Extra Help and assist with the application if appropriate.
COMMON QUESTIONS
Part D Prescription Plans FAQ
What if my drug isn't on the plan's formulary?
You can request an exception, ask your doctor to prescribe a therapeutically equivalent drug that is covered, or switch to a plan that covers your medication during the next enrollment period. This is exactly why we verify your specific drugs against every plan before recommending one.
Can I use any pharmacy with Part D?
Most Part D plans have preferred pharmacy networks where you'll pay the lowest cost-sharing. Using an out-of-network pharmacy may cost more. We factor in your preferred pharmacy when comparing plans.
Do Part D plans cover insulin?
Yes, under the Inflation Reduction Act, Medicare Part D plans cap insulin costs at $35/month per covered insulin product. This applies to all Medicare Part D enrollees regardless of income.
Can I change my Part D plan mid-year?
Generally no, you're locked into your Part D plan until the next Annual Enrollment Period (Oct 15–Dec 7) unless you experience a qualifying Special Enrollment Period event such as moving, losing other coverage, or qualifying for Extra Help.
What is the Part D income-related adjustment (IRMAA)?
Higher-income Medicare beneficiaries pay an additional monthly surcharge on top of their Part D premium, called IRMAA. In 2026, this ranges from about $15 to $91/month based on your income from two years prior. We discuss IRMAA implications for every client we work with.
Should I enroll in Part D if I don't take any prescriptions?
Generally yes, enrolling in a low-premium Part D plan protects you from the late enrollment penalty if you need prescriptions in the future. Plans are available for as little as $5–10/month. The cost of not enrolling can far exceed the cost of a basic plan over time.