Medicare Part D – The Langford Insurance Group

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Eddie Langford

Founder of The Langford Insurance Group · Licensed Since 1994 · Independent Medicare Advisor

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Discover the Medicare Part D Difference

What Is Medicare Part D?

Medicare Part D provides prescription drug coverage through private insurance companies approved by Medicare. You can get Part D as a standalone Prescription Drug Plan (PDP) alongside Original Medicare, including when you have a Medicare Supplement plan, or it may be included with many Medicare Advantage plans that offer prescription drug coverage (MAPD).

Each Part D plan has a formulary, which is the plan’s list of covered prescription drugs. Medications are generally organized into tiers, with different copayments or coinsurance depending on the drug and tier. Formularies, premiums, pharmacies, deductibles, and cost-sharing can change from year to year.

When comparing Part D plans, the lowest monthly premium isn’t necessarily the best value. What matters is how the plan covers your specific medications, which tier they’re on, your preferred pharmacy, and your estimated total yearly prescription costs.

Eddie can help compare your medications against available formularies so you can better understand your coverage options before choosing a plan.

Deductible Phase

Depending on your Part D plan, you may pay the full cost of your covered prescription drugs until you reach the plan’s annual deductible. Not all Part D plans have a deductible, and the amount can vary by plan. Always check the plan’s current deductible, covered medications, and cost-sharing before enrolling.

Initial Coverage Phase

During this phase, you generally pay your plan’s copayments or coinsurance for covered prescription drugs, while your Part D plan pays its share. Your costs continue according to the plan’s coverage rules until you reach the annual out-of-pocket threshold established under Medicare Part D. Once you reach that limit, you move into the next phase of Part D coverage. Your actual costs depend on your plan, medications, pharmacy, and coverage rules.

Catastrophic Coverage Phase

Once you reach the annual Part D out-of-pocket threshold, your covered prescription drug costs are generally $0 for the remainder of the calendar year under the Medicare Part D changes that took effect in 2025. The former “donut hole” coverage gap was eliminated in 2025, making the Part D cost structure simpler and providing stronger protection against high prescription drug costs. Your actual costs can vary based on your medications, plan, and other Medicare coverage.

Starting in 2025: The Donut Hole Is Gone

The Medicare Part D “donut hole” (coverage gap) was eliminated in 2025. Once you reach the annual Part D out-of-pocket threshold for covered prescription drugs, you enter the catastrophic coverage phase and generally pay $0 for covered Part D drugs for the remainder of the calendar year. Your actual costs can vary depending on your medications, plan, and coverage circumstances.

What You Need to Know

Avoid the Part D Late Enrollment Penalty

If you go 63 days or more without Part D or other creditable prescription drug coverage after your Initial Enrollment Period, you may have to pay a late enrollment penalty when you enroll in Part D. The penalty is generally added to your monthly Part D premium for as long as you have Part D coverage. Don’t wait until you need prescriptions to think about Part D. Understanding your enrollment options early can help you avoid unnecessary penalties.

Check Your Drug Coverage Every Year

Your Part D plan’s formulary, drug tiers, premiums, pharmacies, and cost-sharing can change from year to year. A medication that’s covered today could have different costs or coverage rules next year. Review your prescription drug coverage during the Annual Enrollment Period (October 15–December 7) to make sure your plan still fits your medications and needs. Don’t assume your current plan is still your best option—review it every year.

Enrollment Periods Matter

Medicare has specific times to enroll or change coverage. Your Initial Enrollment Period (IEP) is a 7-month window around your 65th birthday. The Annual Enrollment Period (AEP) runs October 15–December 7 each year. Special Enrollment Periods (SEPs) may also apply after qualifying life events. Understanding your enrollment window can help you avoid costly delays and penalties.

Key Cost Components

Cost Component	Description
Monthly Premium	Varies by plan; the base beneficiary premium is $38.99.
Deductible	Up to $615, depending on the plan.
Copayments/Coinsurance	Costs for medications after meeting the deductible; varies based on the drug tier and plan specifics.
Late Enrollment Penalty	A penalty may apply if you enroll in Part D after your initial eligibility period without having other credible prescription drug coverage.

Enrollment Periods

Initial Enrollment Period (IEP): Begins three months before, includes the month of, and ends three months after your 65th birthday or Medicare eligibility date.
Annual Enrollment Period (AEP): October 15 to December 7 each year; during this time, you can join, switch, or drop a Part D plan.
Special Enrollment Periods (SEPs): Available for qualifying life events, such as moving out of your plan’s service area or losing other credible drug coverage.

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Frequently Asked Questions

Your Medicare Questions, Answered

Medicare Part D has multiple cost phases throughout the year: the deductible phase, initial coverage phase, coverage gap (formerly the “donut hole”), and catastrophic coverage phase. As your total drug spending increases, your cost-sharing changes. Understanding how your medications move through these phases helps estimate your total annual prescription costs.

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A formulary is the plan’s official list of covered medications. Drugs are placed into different tiers, with lower tiers typically costing less. Formularies can change annually, so reviewing your plan each year ensures your medications remain covered at a reasonable cost.

If you do not enroll in Medicare Part D when first eligible and do not have other creditable prescription drug coverage, you may face a late enrollment penalty. This penalty is added to your monthly premium and generally continues for as long as you have Part D coverage.

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