Need an affordable
Medicare Advantage Part D?
Find an Affordable Medicare Part D Plan that's right for you.
Need an affordable
Medicare Part D Plan?
Find an Affordable Medicare Part D Plan that's right for you.
Prescription Drug Plans (Part D)
What Is Medicare Advantage Part D?
Medicare Advantage Part D prescription drug coverage, often referred to as Part D, is available from private insurers to anyone who is also eligible for Original Medicare and permanently resides in the service area of a Medicare Prescription Drug Plan. Different insurers offer different types of plans, so your premium and out-of-pocket expenses for prescription drugs will vary.
Medicare Part D is prescription drug coverage. You can get Medicare Part D coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage prescription drug plan. Both are available from Medicare-approved private insurance companies.
Medicare Part D coverage is optional, but if you don’t enroll in Medicare Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later.
Your monthly plan premium and out-of-pocket expenses for prescription drugs will vary from plan to plan.
What’s NEW for 2025 (Quick‑look)
- $2,000 annual out‑of‑pocket cap on prescription drugs for all Medicare Part D and Medicare Advantage‑Prescription Drug (MA‑PD) plans.
- Standard Part D deductible rises to $590.
- The “donut hole” coverage gap is eliminated; after you meet the deductible you pay your plan’s cost‑sharing until you hit the $2,000 cap, then nothing for the rest of the year.
- Drug‑cost smoothing option: elect to spread your Part D cost‑sharing evenly over 12 months instead of paying large amounts early in the year.
- Extra Help (Low‑Income Subsidy) expansion: full benefits now available to people with incomes up to 150 % of the federal poverty level (no premium, no deductible, very small copays).
- Insulin still capped at $35 per month and ACIP‑recommended vaccines remain $0.
- Average standalone Part D premium projected to remain around $31.50, while average MA‑PD premium dips to roughly $17
2025 Medicare Advantage highlights
Feature | 2024 | 2025 |
Average MA premium | $18.23 | $17.00 |
Maximum in‑network MOOP | $8,850 | $9,200 |
Rx out‑of‑pocket cap | $8,000 | $2,000 |
Mid‑year unused‑benefit statement | N/A | Yes |
GUIDE caregiver support benefit | Pilot | Nationwide pilot |
Tip for shoppers: Even with lower premiums, look closely at a plan’s MOOP, provider network, and supplemental benefits (dental, vision, OTC) before enrolling.
2025 Part D cost breakdown
Part D benefit parameter | 2024 amount | 2025 amount |
Annual deductible | $545 | $590 |
Out‑of‑pocket (TrOOP) threshold | $8,000 | $2,000 |
Coinsurance in catastrophic phase | 0 % | 0 % |
After you hit $2,000 in true out‑of‑pocket costs (including manufacturer discounts), you pay $0 for covered drugs for the rest of the calendar year.
What's Covered?
Medicare Part D covers your prescription drugs. Each private plan offered through Part D must provide a standard level of coverage set by Medicare. The requirements mean most plans have sizable formularies with the capability to prescribe medications for many illnesses. Private insurance carriers have control over the drugs they cover and the “tiers,” which affect the cost. Take a look at our Medicare Part D coverage guide for more information.
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What else should you know about Medicare Part D prescription drug plans?
No matter what type of Medicare prescription drug plan you have, here are some things to keep in mind.
- If the plan has an annual deductible, you generally pay the full amount of your prescription drug purchases until the deductible is met.
- After you satisfy the annual deductible, you will pay a share of the costs according to the terms of your plan. Your share, which you typically pay to the pharmacy at the time of pickup, could be a flat amount (copayment) or a percentage of the total amount (coinsurance).
- If you and your plan spend a combined $4,020 in 2020 (an amount called the initial coverage limit), you’ll enter a different Medicare Part D coverage phase. During this phase, you’ll pay no more than 25% of the cost for each covered prescription. The initial coverage limit may change from year to year.
- Once you have paid a certain annual maximum amount out of your own pocket for covered prescription drugs, you automatically get “catastrophic coverage.” This means for the rest of that particular year, you would only pay a small copayment or coinsurance amount for prescription drugs. Medicare Part D catastrophic coverage begins when you’ve spent $6,350 in 2020. This amount may change from year to year.
Be sure to talk to your doctor to see if you are taking the lowest cost medications available to you. Specific coverage may vary from plan to plan, so read your documentation carefully.
Who’s Eligible for Part D Insurance?
You are eligible for a Medicare Part D plan if:
You may enroll in a Part D or MA‑PD plan if you:
- Are entitled to Medicare Part A and/or enrolled in Part B.
- Permanently reside in the plan’s service area.
- Are U.S. citizens or lawfully present.
Most people first become eligible at age 65, or earlier if they’ve received SSDI for 24 months or have End‑Stage Renal Disease (ESRD) or ALS.
How Do I Enroll in Part D for 2025?
- Initial Enrollment Period (IEP): 7‑month window around your 65th birthday.
- Annual Medicare Open Enrollment (AEP): October 15 – December 7, 2025 (coverage effective January 1, 2026).
- Medicare Advantage Open Enrollment Period (MA‑OEP): January 1 – March 31, 2025 (one‑time switch for MA enrollees).
- Special Enrollment Periods (SEPs): for life events such as moving out of your plan’s area, losing other creditable drug coverage, or qualifying for Extra Help.
New to Medicare and Part D?
If you’re preparing to enroll for the first time, the initial Medicare enrollment period is open for seven months. We think it’s easiest to explain initial enrollment when you slice it three ways:
- You can enroll in the three months before your 65th birthday month. Coverage begins the first day of your birthday month.
- You can enroll the month of your birthday. Coverage begins the first day of the month after your birthday.
- You can enroll in the three months after your birthday month. Coverage begins the first day of the month after enrollment. For example: Let’s say you turn 65 on July 15. Your Initial Enrollment Period begins April 1 and ends October 31.
For example: Let’s say you turn 65 on July 15. Your Initial Enrollment Period begins April 1 and ends October 31.
What if the drug I need isn’t covered?
Each Part D plan has a formulary. Simply, it’s a list of the drugs covered. If the drug you need is not on a formulary, you can request an exception. You can contact the carrier to ask if your drug has a different name you don’t recognize. Part D offers at least two types of drugs in most categories, and is required by Medicare to cover all drugs in the six most essential categories.
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Prescription Drug Plans (Part D)
What Is Medicare Part D?
Medicare Advantage Part D prescription drug coverage, often referred to as Part D, is available from private insurers to anyone who is also eligible for Original Medicare and permanently resides in the service area of a Medicare Prescription Drug Plan. Different insurers offer different types of plans, so your premium and out-of-pocket expenses for prescription drugs will vary.
Medicare Part D is prescription drug coverage. You can get Medicare Part D coverage through a stand-alone Medicare prescription drug plan or a Medicare Advantage prescription drug plan. Both are available from Medicare-approved private insurance companies.
Medicare Part D coverage is optional, but if you don’t enroll in Medicare Part D as soon as you’re eligible, you might pay a late-enrollment penalty if you enroll later. Your monthly plan premium and out-of-pocket expenses for prescription drugs will vary from plan to plan.
What's Covered?
Medicare Part D covers your prescription drugs. Each private plan offered through Part D must provide a standard level of coverage set by Medicare. The requirements mean most plans have sizable formularies with the capability to prescribe medications for many illnesses. Private insurance carriers have control over the drugs they cover and the “tiers,” which affect the cost. Take a look at our Medicare Part D coverage guide for more information.
What else should you know about Medicare Part D prescription drug plans?
No matter what type of Medicare prescription drug plan you have, here are some things to keep in mind.
- If the plan has an annual deductible, you generally pay the full amount of your prescription drug purchases until the deductible is met.
- After you satisfy the annual deductible, you will pay a share of the costs according to the terms of your plan. Your share, which you typically pay to the pharmacy at the time of pickup, could be a flat amount (copayment) or a percentage of the total amount (coinsurance).
- If you and your plan spend a combined $4,020 in 2020 (an amount called the initial coverage limit), you’ll enter a different Medicare Part D coverage phase. During this phase, you’ll pay no more than 25% of the cost for each covered prescription. The initial coverage limit may change from year to year.
- Once you have paid a certain annual maximum amount out of your own pocket for covered prescription drugs, you automatically get “catastrophic coverage.” This means for the rest of that particular year, you would only pay a small copayment or coinsurance amount for prescription drugs. Medicare Part D catastrophic coverage begins when you’ve spent $6,350 in 2020. This amount may change from year to year.
Be sure to talk to your doctor to see if you are taking the lowest cost medications available to you. Specific coverage may vary from plan to plan, so read your documentation carefully.
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Who’s Eligible for Part D Insurance?
You are eligible for a Medicare Part D plan if:
- You are 65 years of age or older.
- You have a qualifying disability for which you have been receiving Social Security Disability Insurance (SSDI) for more than 24 months.
- You have been diagnosed with End-Stage Renal Disease (permanent kidney failure requiring a kidney transplant or dialysis).
- You are entitled to Medicare Part A or Part B. You should consider Part D if you enroll in Original Medicare and you:
- Have a regular prescription drug need.
- Will have a prescription drug need in the future.
- Have trouble paying for your current prescription drug needs.
- Do not have prescription drug coverage.
- Want to avoid a penalty.
How Do I Enroll in Part D?
The Open Enrollment Period for Medicare and Part D is October 15 to December 7. If you don’t purchase a plan then, you may qualify for a Special Enrollment Period (SEP).
Find Medicare Plans in 3 Easy Steps
We can help get up to $0 monthly premium Medicare plans
New to Medicare and Part D?
If you’re preparing to enroll for the first time, the initial Medicare enrollment period is open for seven months. We think it’s easiest to explain initial enrollment when you slice it three ways:
- You can enroll in the three months before your 65th birthday month. Coverage begins the first day of your birthday month.
- You can enroll the month of your birthday. Coverage begins the first day of the month after your birthday.
- You can enroll in the three months after your birthday month. Coverage begins the first day of the month after enrollment. For example: Let’s say you turn 65 on July 15. Your Initial Enrollment Period begins April 1 and ends October 31.
For example: Let’s say you turn 65 on July 15. Your Initial Enrollment Period begins April 1 and ends October 31.
What if the drug I need isn’t covered?
Each Part D plan has a formulary. Simply, it’s a list of the drugs covered. If the drug you need is not on a formulary, you can request an exception. You can contact the carrier to ask if your drug has a different name you don’t recognize. Part D offers at least two types of drugs in most categories, and is required by Medicare to cover all drugs in the six most essential categories.
