How Much Does Medicare Part D Cost?
About Medicare Part D
Original Medicare Parts A and B don’t cover prescription drug costs, outside of medications prescribed to you during a hospital stay. Medicare Part D is standalone prescription drug coverage you can enroll in through a private insurer, like Anthem. Its costs and coverage vary based on your location and the plan you select. Many Medicare Advantage (Part C) plans also include Part D prescription drug coverage and additional benefits with $0 or low monthly premiums. Here’s a breakdown of standalone Medicare Part D costs.
Medicare Part D Premiums And Deductibles
Most Part D plans have deductibles, premiums and/or copays or coinsurance for which you are responsible. Each year, the government sets a maximum limit on annual deductibles.
That limit is a good benchmark for comparing plan deductibles. Keep in mind that a plan with a $0 deductible may mean you'll pay higher copays and/or monthly premiums.
Medicare Part D Copay And Coinsurance Options
Your copay is a set amount you pay for prescriptions when you pick them up at the pharmacy. Generic medications often cost less than brand-name prescription drugs.
You'll find that more expensive medications usually have a coinsurance for you to pay. When you research a plan, see what your share of the cost will be for medications you need.
Drug Tiers And Medicare Part D Costs
Every drug on a drug list is in a cost-sharing tier. What you pay for your prescription depends, in part, on which tier your drug is in. Your prescription may fall under different drug tiers depending on its availability in generic or brand form, as well as the associated cost. Each drug tier has a set copay or coinsurance cost. Here's an example of how the tiers may work:
| TIERS | DESCRIPTION |
|---|---|
|
Tier 1 |
Preferred Generic. These are usually the lowest cost generic versions of brand-name drugs. |
|
Tier 2 |
Generic. These are usually higher-cost generic drugs. |
|
Tier 3 |
Preferred Brand. These are typically lower-cost, preferred brand-name drugs and some high-cost generic drugs. |
|
Tier 4 |
Non-Preferred Drug. These are typically higher-cost, non-preferred generic and brand-name drugs. |
|
Tier 5 |
Specialty Tier. Includes specialty drugs often used to treat serious illnesses. Drugs in this tier generally cost more than other drug tiers but may include both generic and brand-name drugs. |
Check to make sure the plan covers the medications you need most. Then you can do a Medicare Part D cost comparison.
Is the Medicare donut hole going away?
Yes. In previous years, you faced a coverage gap when you and your health plan spent a certain amount on your medications ($5,030 in 2024). After that you were required to pay 25% of your prescription drug costs until you reached an $8,000 annual out-of-pocket limit. Starting January 1, 2025, you will not pay anything for covered medications after you reach a $2,000 annual out-of-pocket limit.
Avoiding The Medicare Part D Penalty
If you don’t sign up for a Part D plan when you’re first eligible, or you’ve gone 63 days or more without creditable drug coverage after your Initial Enrollment Period (IEP), you’ll pay a monthly late enrollment Medicare Part D penalty while you have Part D coverage. While the fee is typically only a few dollars each month, it can add up over time.
Getting Help With Medicare Part D Costs
Costs for Medicare Part D can vary, and for those who need help, there is assistance available. Extra Help is a federal program that helps with Medicare Part D costs. Depending on your financial situation, it can pay for some or all of your prescription drug coverage.
Other Ways To Pay For Medicare Part D Costs
Starting in 2025, new rules make it easier to manage your out-of-pocket prescription drug costs. You can enroll in the new Medicare Prescription Payment Plan designed for members with high out-of-pocket prescription drug costs. This will let you make monthly payments versus paying the entire amount upfront. Participation in this program is completely optional. You will receive enrollment instructions from your health plan or give us a call if you have questions.
When researching Part D plans, look at everything you pay for Medicare. You may find that a Medicare Advantage plan that includes prescription drug coverage along with other benefits could be a better choice for your budget.
When you sign up for Medicare, look at all Part D plans that fit your drug coverage needs. Compare them with your Medicare costs and see what works for you.
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Read Our Other Medicare Articles
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How To Apply For Medicare
Medicare Advantage Vs Original Medicare
Medicare Part D Enrollment
About Medicare Enrollment
Medicare Eligibility
What Does Medicare Cover?
Medicare Advantage Open Enrollment
Medicare Advantage Enrollment
Medicare Part D Plans
Turning 65
Why Choose Anthem?
Anthem Blue Cross, a Medicare Advantage organization with a Medicare Contract, offers HMO, HMO D-SNP, HMO C-SNP, and HMO I-SNP plans. Anthem Blue Cross Partnership Plan, a Medicare Advantage Organization with a Medicare Contract, offers HMO and HMO-CSNP plans. Anthem Life and Health Insurance Company, a Medicare Advantage Organization with a Medicare Contract, offers LPPO, LPPO D-SNP, and LPPO C-SNP plans. Anthem Blue Cross HMO D-SNP plans and Anthem Life and Health Insurance Company LPPO D-SNP plans additionally contract with state Medicaid programs. Anthem BC Health Insurance Company, a Medicare Advantage Organization with a Medicare Contract, offers LPPO plans. Enrollment in an Anthem Blue Cross, Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Life and Health Insurance Company plans depend on contract renewal.