Medicare Part D
Prescription Drug Plans
Seniors Primero Insurance Agency serves seniors and families in the communities we cover, comparing Medicare Part D Prescription Drug Plans by phone at no cost. We run every medication against each plan's formulary so you can see real annual costs before you enroll.
What is Medicare Part D?
Medicare Part D is the federal prescription drug benefit, offered by private Medicare approved insurance carriers. You can get Part D coverage two ways: as a standalone Prescription Drug Plan (PDP) that pairs with Original Medicare or a Medicare Supplement, or built in to a Medicare Advantage Prescription Drug (MAPD) plan. Each Part D plan publishes a formulary, the list of covered drugs organized into tiers, and contracts with a network of preferred and standard pharmacies that affect your copays.
Why the formulary matters more than the premium
Two Part D plans with similar monthly premiums can have wildly different out of pocket costs depending on how your specific medications are tiered, whether your pharmacy is preferred, and whether step therapy or prior authorization apply. A Medicare agent compares plans on projected annual cost, premium plus deductible plus copays, not just the premium.
Key Part D features to compare
- Formulary tier, most plans use 5 tiers, with generics on the lowest tiers and specialty drugs on the highest.
- Preferred pharmacies, copays can drop significantly when you fill prescriptions at a plan's preferred pharmacy.
- Mail order options, 90 day supplies are often the lowest cost option for maintenance medications.
- Annual out of pocket cap, beginning in 2025, Medicare Part D caps out of pocket prescription costs at $2,000 per year.
The Part D late enrollment penalty
If you go more than 63 consecutive days without creditable prescription drug coverage after your Initial Enrollment Period, Medicare adds a permanent late enrollment penalty to your Part D premium. The penalty grows the longer you wait. Even if you take no prescriptions today, most beneficiaries enroll in a low cost plan to keep their coverage protected for the future.
When you can enroll
Initial Enrollment runs 3 months before, the month of, and 3 months after you turn 65. The Annual Enrollment Period (October 15 to December 7) is the main window each year to switch Part D plans. Special Enrollment Periods may apply if you move, lose employer drug coverage, or qualify for Extra Help / Low Income Subsidy.
FAQ
Medicare Part D frequently asked questions
What does Medicare Part D cover?
Medicare Part D is the federal Prescription Drug program offered by private Medicare approved carriers. Each plan publishes a formulary, a list of covered drugs organized into tiers, along with a pharmacy network, copays, and deductible.
Do I need a Part D plan if I rarely take medication?
Most beneficiaries enroll in a Part D plan or a Medicare Advantage plan that includes Part D to avoid the late enrollment penalty, which is added to your premium permanently if you go without creditable drug coverage for more than 63 consecutive days.
What is the Part D coverage gap (donut hole)?
Beginning in 2025, Medicare Part D includes a $2,000 annual out of pocket cap on covered prescription drugs, and the traditional donut hole has been replaced with a simpler benefit structure. Costs vary by plan.
Can a Medicare agent help me pick a Part D plan?
Yes. Seniors Primero compares standalone Part D plans across multiple carriers, runs your specific medications through each plan's formulary, and identifies the plan with the lowest projected annual cost.
Free Part D formulary check
Send us your medication list, we'll compare plans side by side.