What Part D is
Part D is Medicare drug coverage. You get it from a private insurance company approved by Medicare. You can get it two ways: as a stand-alone drug plan that goes with Original Medicare (and a Medicare Supplement, if you have one), or built into most Medicare Advantage plans.
What it covers
Each plan has a formulary, which is its list of covered drugs. All Part D plans must cover a wide range of medicines, but the lists are not the same. A drug one plan covers may not be on another plan's list.
Drugs on the list are sorted into tiers. Lower tiers, often generic drugs, usually cost less. Higher tiers, like brand names and specialty drugs, usually cost more. The same drug can sit on a different tier in a different plan.
Plans also have preferred pharmacies. You can often fill at many pharmacies, but your cost may be lower at the plan's preferred ones. Mail order may be an option too. If you like your local pharmacy, tell us, and we will check it.
What you pay
You may pay a monthly premium, a yearly deductible, and a copay or coinsurance each time you fill a prescription. The good news is that there is now a yearly cap on what you pay out of pocket for covered drugs. Once you reach it, you pay nothing more for covered drugs for the rest of the year. See this year's cap on our Medicare costs page.
Spreading out your costs
All Medicare drug plans offer the Medicare Prescription Payment Plan. It is optional and free to join. Instead of paying at the pharmacy counter, you get a monthly bill from your plan, spread across the year. It does not lower your total drug costs. It can help if you have large costs early in the year. Your plan can tell you how to sign up. You can read more on Medicare.gov.
Who it fits best
A stand-alone Part D plan fits people with Original Medicare who want help paying for prescriptions. If you are looking at Medicare Advantage, your drug coverage is usually part of that plan instead.
The late penalty
If you go 63 days or more in a row without Part D or other creditable drug coverage after your first chance to sign up, you may owe a late penalty. It is added to your premium, and it generally lasts as long as you have Medicare drug coverage. People who get Extra Help do not pay it. If you have drug coverage from work, the VA or TRICARE, ask us before you decide to skip Part D.
Review your plan every fall
Drug plans can change every year. A plan may drop a drug, move it to a higher tier, change its preferred pharmacies, or change its price. Your plan sends a notice each fall that lists the changes, but it is easy to miss.
That is why we review your drug plan with you each year during the Annual Enrollment Period, from October 15 to December 7. If your plan still fits, we will tell you. See enrollment periods for all the dates.
What to send us
To check plans for you, we need a few things. A photo of your pill bottles works fine.
- The name of each medicine
- The dose (for example, the number of milligrams) and how often you take it
- The pharmacy you use, or if you use mail order
We will look up each medicine in the plans we offer and show you what each plan covers and what it costs.
Call us first. Before you switch drug plans, talk with a local agent. It is free, and the price is the same as going direct. Call (816) 307-6165 or book a free review.
Questions people ask us
Is Medicare Part D ending in 2027?
No. Part D drug coverage continues in 2027. Some drug plans may leave certain areas or change their benefits, so check your Annual Notice of Change letter and review your plan during open enrollment.
What is the Part D deductible for 2027?
Medicare set the highest deductible a Part D plan can have in 2027. Many plans have a lower deductible or none. See the exact amount on our Medicare costs page.
Do I need Part D if I take no medicines?
Many people still get a drug plan, because waiting can mean a late penalty later. If you have other creditable drug coverage, you may not need one. We can talk through your situation.
What is creditable coverage?
It is drug coverage that is expected to pay, on average, at least as much as standard Medicare drug coverage. Employer, union, VA and TRICARE coverage often count. Your plan should send you a yearly notice that says so.
Can my plan change during the year?
Plans mostly change at the start of each year. That is why the fall review matters. If a plan changes its drug list during the year, it generally has to let affected members know.
Does the Medicare Prescription Payment Plan save money?
No. It does not lower your drug costs. It spreads what you owe into monthly bills instead of paying at the pharmacy counter.
What if a medicine I take is not covered?
Your doctor can ask the plan for an exception, or you may be able to switch to a similar covered drug. We can also look for a plan that covers it at your next chance to change.