Medicare Part D Options

Behind these curtains could be the prescription coverage you need… or a costly surprise. Which will you choose?

Medicare Part D — your prescription drug coverage — comes in two ways: stand-alone Part D plans (PDPs) and Medicare Advantage Plans with drug coverage included (MAPDs). They have three things in common:

• Drugs are grouped into tiers — generics (lowest cost), preferred brands, non-preferred, and specialty drugs (highest cost).

• The same drug can land in a different tier depending on the plan.

• Even your pharmacy choice (or using mail order) can change your price.

Let’s open the curtains and see how they differ.

Curtain #1 – Stand-Alone Prescription Drug Plans (PDPs)

If you stick with Original Medicare, you’ll need to add a stand-alone Part D plan. These are offered by private insurance companies, and each plan comes with its own mix of:

• Monthly premiums (the cost you pay each month to stay in the plan)

• Deductibles (what you pay out of pocket before the plan begins to help)

• Formularies (the official list of drugs the plan covers and at what cost level)

• Copays (the fixed amount you pay for a prescription)

Here’s the catch: low monthly premium plans often come with high deductibles, for brand-name drugs. On the other hand, plans with higher premiums may eliminate the deductible altogether and cover costly medications better.  You have to check carefully to make sure it’s the prize you want.

Curtain #2 – Medicare Advantage Plans (MAPDs)

Medicare Advantage Plans bundle your Part D drug coverage right inside the plan.

• Some may have lower deductibles compared to stand-alone Part D plans

• In some cases, lower drug costs at the pharmacy

• Premiums can start as low as $0, but drug costs still vary from plan to plan

In other words, sometimes this curtain hides a brand-new car, but you’ve got to compare to know for sure.

Curtain #3 – The Zonk (The Penalty)

If you don’t enroll in Part D when you’re first eligible — and you don’t have other creditable drug coverage — you’ll face a penalty of 1% per month for every month you go without it. That penalty is permanent. Once it’s added, you’ll pay it as long as you’re on Medicare.

Bonus Round – When comparing plans, it’s important to know:

• The exact spelling of your medication

• The dosage and frequency

• For liquids, gels, or drops: the strength, quantity per month, size (ml)

So, which curtain should you pick? The key is comparing your prescriptions across both PDPs and MAPDs to see which one really is the best deal.  And remember — you don’t have to play the game alone. We’re here to help you compare plans, explain your choices, and make sure you walk away with the right prize. 

Medicare Part D Choices