Medicare Part D Drug Plans 2025
- Diane Andree
- Sep 26
- 2 min read
Welcome to the Medicare Malt Shop! Pull up a red stool, the jukebox is humming, and you were just handed the menu. Instead of sundaes and banana splits, today’s specials are Medicare Part D drug plans. Because, just like a malt shop menu, these plans come in different “flavors” and prices —knowing what you’re ordering makes all the difference.
The Menu: Tiers Explained
Every drug plan starts with its “menu” — officially called a formulary. That’s just a fancy word for the list of medications the plan covers. The menu is divided into tiers:
Tier 1 Scoop – Preferred Generics (cheapest, like plain vanilla)
Tier 2 Double Scoop – Non-Preferred Generics (a little pricier)
Tier 3 Shakes – Preferred Brand Names (smooth but costs more)
Tier 4 Sundaes – Non-Preferred Brand Names (sweet but pricey)
Tier 5 Banana Split – Specialty Drugs (the deluxe dessert with a deluxe price tag)
Each tier comes with a different copay or coinsurance. Just like ordering a sundae costs more than a scoop, higher-tier drugs come with higher out-of-pocket costs.
The Cover Charge: Deductibles
Before your plan starts picking up the tab, you may need to pay a deductible the amount you pay out of pocket first, before the plan kicks in. In 2025, that’s up to $590 (maximum set by CMS). Most plans skip this for the generic tiers, and some lower the deductible or waive it completely for the name brand tiers. These plans typically have a higher premium cost.
Stages of Coverage: From Scoops to Splits -The roadmap to your Part D dessert bar:
Deductible Stage – you pay out-of-pocket first before the plan benefits kick in.
Initial Coverage Stage – you pay 25% until your total out-of-pocket hits $2,000.
Catastrophic Coverage – Copays for covered drugs $0 for the rest of the year.
Extra “House Rules” - Part D plans also add some fine print
Step Therapy – try the less expensive scoop first, but may pay for the sundae if needed.
Prior Authorization – the doctor obtains the plan’s permission by showing need.
Quantity Limits – no triple-scooping opioids (for safety and cost reasons).
Where You Order Matters
Not all pharmacies charge the same. Plans often have “preferred” pharmacies where your copays are lower. And don’t forget mail order: prescriptions shipped straight to your home.
Menus can get confusing. A licensed Medicare broker can compare the choices for you and help you find the plan that makes your prescriptions (and your wallet) happiest.
👉 Diane Andree, Medicare Plan Specialist
📞 631-337-3625
🌐 ABC Medicare Plan Brokers
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