Medicare Part D

What is Medicare Part D? (Prescription Drug Benefit)

Medicare Part D is a voluntary outpatient prescription drug benefit for people with Medicare, provided through private plans approved by the federal government. Beneficiaries can choose to enroll in either a stand-alone prescription drug plan (PDP) to supplement traditional Medicare or a Medicare Advantage prescription drug plan (MA-PD), mainly HMOs and PPOs that cover all Medicare benefits including drugs. As of June 2024, 53 million of the more than 67 million people covered by Medicare are enrolled in Part D plans.

How does Medicare Part D work?

Medicare offers two ways to get prescription drug coverage - Part D and Medicare Advantage.  Medicare Part D is one component of the overall Medicare program.

While Medicare extends to a wide variety of medical treatments, Part D is focused specifically on making drug prices more affordable for Americans 65 years and older.

People already covered by Medicare generally can opt in to Medicare Part D.  When you do, you will be charged the same kinds of costs found with standard insurance plans, such as monthly premiums, annual deductibles, and various copays. In exchange, you get additional coverage for prescription drugs as compared to what is already offered by the broader Medicare program.  We can help you determine whether enrolling in Medicare Part D makes economic sense, based on your health needs and financial circumstances.

How much does Medicare Part D cost?

You’ll make these payments throughout the year in a Medicare Part D drug plan:

  • Premium
  • Yearly Deductible
  • Copayments or Coinsurance
  • Costs if you get Extra Help
  • Costs if you pay a Late Enrollment Penalty
  • In 2026, the Out-of-Pocket Maximum is $2,100

Your actual drug coverage costs will vary depending on:

Your prescriptions and whether they’re on your plan’s list of covered drugs  (formulary).

  • What “tier” the drug is in.
  • Which drug benefit phase you’re in (like whether you’ve met your deductible or if you’re in the catastrophic coverage phase).
  • Which pharmacy you use (whether it offers preferred or standard cost-sharing, is out of network, or is mail order).  Out-of-pocket drug costs may be less at a preferred pharmacy because it has an agreement with your plan to charge less.
  • Whether you get extra help paying your drug coverage costs.

Learn More About Our Team

Shane Quintana, LUTCF
Business and Estate Planning Specialist
About Shane
Donna Quintana, RHU
Employee Benefits and Health Insurance Specialist
About Donna

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The Quintana Group is not connected with or endorsed by the U.S. Government or with the federal Medicare program. We do not offer every plan available in your area. Currently, we represent 10 organizations in 2 states which offer 46 plans (plan availability depends on the zip code in which you reside). Please contact Medicare.gov, 1-800-Medicare or your local State Health Insurance Program (SHIP) to get information on all of your options.

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