Original Medicare does not cover prescriptions you pick up at the pharmacy. To get drug coverage, you’ll need to enroll in either a standalone Part D Prescription Drug Plan (if you have a Supplement/Medigap Plan) or a Medicare Advantage Plan with drug coverage (MAPD).

Choosing the right drug plan is very personal. Your prescriptions and preferred pharmacy play a big role in which plan will fit you best. Each plan has its own formulary (list of covered drugs) and preferred pharmacy network, which affects what you pay. Drugs are placed in “tiers,” and your cost depends on which tier your medications fall under.

How Part D Drug Coverage Works

Beginning in 2025, Part D plans will include big improvements:

• After meeting your plan’s deductible (if it has one), you’ll pay copays or coinsurance for prescriptions at the pharmacy.

• Once your out-of-pocket costs reach $2,000, your covered prescriptions will be $0 for the rest of the calendar year.

• Costs reset each January.

Another option starting in 2025 is the Medicare Prescription Payment Plan (M3P). Instead of paying large amounts at the counter for expensive medicines early in the year, you can spread your costs into predictable monthly payments through your insurance company. You can opt into this program at any time by calling your plan.

Help for Those with Limited Resources

If your income and assets fall below government limits, you may qualify for Extra Help (Low-Income Subsidy) through Social Security. This program reduces your drug plan premiums and copays at the pharmacy. You can apply online at ssa.gov or by calling 1-800-772-1213.

Our team can also help guide you through the application process so you don’t have to figure it out alone.

When You Can Change Your Part D Plan

After you choose a Part D plan, you generally must stay in it for the calendar year. The main time to change is during the Annual Enrollment Period (AEP):

• October 15 – December 7 for a January 1st start date.

There are a few Special Enrollment Periods (like moving out of your service area, entering a nursing home, or qualifying for Extra Help), but for most people, changes only happen in the fall.

Why Choosing the Right Plan Matters

Not all Part D plans are created equal. Even with the same premium, plans can vary widely in what they cover and what you’ll pay at your pharmacy. Small details—like whether your preferred pharmacy is “in-network” or whether your drug is on a lower tier—can make a big difference in your costs.

That’s why we encourage you not to make this decision alone. If you’re new to Medicare, we’ll guide you through your options. If you’ve been on Medicare for a while, we’ll review your prescriptions during the fall to see if your current plan is still the right fit for the upcoming year.

Local, Professional Support

At Imagine Insurance Advisors, our licensed agents are available to give you a complimentary, no-obligation review of your drug coverage. Whether it’s your first time enrolling or time to re-evaluate your plan, we’ll help you:

Compare plans available in your county
Review your prescriptions and pharmacy preferences
Choose a plan that fits your health and budget needs