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Prescription drug coverage – or Medicare Part D – subsidizes the costs of brand-name and generic prescription drugs for Medicare beneficiaries. Medicare recipients choose the coverage by enrolling in either a stand-alone prescription drug plan (PDP) – which covers only prescription drugs – or a Medicare Advantage plan with integrated Part D coverage (MAPD), which covers prescriptions and other medical expenses.
Part D plan design varies from one plan to another. Plans can have deductibles (the maximum deductible is $545 in 2024 and $590 in 20251), and then there’s an initial coverage phase, during which the plan can require copays or coinsurance of up to 25% of the cost of the drugs.
There used to be a coverage gap (donut hole) phase after that, during which the enrollee paid up to 25% of the cost of their drugs. But starting in 2025, the coverage gap phase is being eliminated, and enrollees will remain in the initial coverage phase until they reach a $2,000 out-of-pocket cap2 (that limit will be indexed for inflation in future years).
Before 2024, enrollees continued to pay up to 5% of the cost of their drugs once they got out of the coverage gap and entered the catastrophic coverage phase. And there was no limit on how high their spending could be. That changed as of 2024, under the Inflation Reduction Act, which eliminated out-of-pocket costs during the catastrophic coverage phase.
As of 2024, roughly 54 million Medicare beneficiaries were enrolled in Part D coverage. Well over half of them (about 31 million) were enrolled in MAPDs, while about 23 million were enrolled in PDPs.3 There are more than 67 million Medicare beneficiaries, but some do not need to purchase Part D coverage because they have drug coverage from a current or former employer.
Which prescription drug plan should you choose?
Footnotes
Under the new law, Medicare beneficiaries will see a series of prescription drug-pricing provisions phased in – mostly over the next several years
We asked how confident our readers were with comparison shopping for a Medicare Part D plan during the 2022 Medicare Annual Enrollment Period. Here's what we learned from more than 350 survey responses.
in our latest survey, we asked how often our readers review their Part D coverage options. The good news? More than a third of respondents review their options annually.
Reasons to consider a change to your Medicare prescription drug coverage may include high premiums, changes to your prescriptions or your plan's formulary, and your access to in-network pharmacies.
But prescription drugs – and drug coverage – can be less expensive if you're willing to do a little research and to reach out for help. Here are eight strategies that will empower you to take control of your drug coverage and your medication costs.
Under the new law, Medicare beneficiaries will see a series of prescription drug-pricing provisions phased in – mostly over the next several years
We asked how confident our readers were with comparison shopping for a Medicare Part D plan during the 2022 Medicare Annual Enrollment Period. Here's what we learned from more than 350 survey responses.
in our latest survey, we asked how often our readers review their Part D coverage options. The good news? More than a third of respondents review their options annually.
Reasons to consider a change to your Medicare prescription drug coverage may include high premiums, changes to your prescriptions or your plan's formulary, and your access to in-network pharmacies.
But prescription drugs – and drug coverage – can be less expensive if you're willing to do a little research and to reach out for help. Here are eight strategies that will empower you to take control of your drug coverage and your medication costs.
