Part D Prescription Drug Plans
Inflation Reduction Act - 2025/2026 Changes to Part D (Rx Plans)
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You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday, or if you are under 65 and eligible for Medicare.
It's important to do this on time because there' may be a permanent premium surcharge for enrolling after your initial enrollment period if you don't have equivalent drug coverage from another source, such as a retiree plan.
Let us help you with your Enrollment
If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.
To Review Your Best Options, can Call / Text at 346-567-8300, E-mail or Schedule an Appointment at the top right of this web site.
Making Part D Work
In 2025, there are out-of-pocket drug costs before you can qualify for catastrophic coverage. The out-of-pocket spending is capped at $2,000 in 2025, $2,100 for 2026. Further, a new Medicare Prescription Payment Plan (M3P) helps "smooth" monthly costs to help you stabilize your monthly costs.
The standard deductible is $590 in 2025, $615 for 2026 while the initial coverage limit slightly goes up to $2,100 in 2026, the Coverage Gap had been eliminated as of 2025.
Drug Manufacturer participation in 2025 is limited to brand named medications, usually found in Drug Tiers 3-5 on most plans. During the initial coverage phase they contribute 10% of brand named medication costs - in the background - that is, contributions are factored into plan copays or coinsurances paid at point of sale or included in the M3P monthly payment. During catastrophic coverage, contributions are 20% for brand named medications; again contributions are factored into plan copays or coinsurances paid at point of sale or included in the M3P monthly payment .
Startimg in 2025, beneficiairies will have access to the Medicare Presciption Payment Plan (M3P) allowing them to spread their out of pockets costs equally over the remaining months in year. Geared toward individuals whose prescription costs near or exceed the $2,100 cap early in the year; as example, a beneficiary hitting the cap in January can pickup their first refill and be billed by their Part D plan or their assign in 12 monthly installment payments of approx $175 to cover their $2,100 capped expense. Initial estimates reflect varying payments the first few months then stabilizing for the remaining year. The M3P plan is administered by the Part D plan or their contractor. An individual defaulting on their monthly payment obligation would be terminated from the M3P plan and required to pay all remaining co-pays at checkout.
Choosing a Part D Plan
It pays to review your Part D coverage every year, especially if you have started taking new drugs.
- We can assist with this over the phone, or we have an online tool to get you started. Here you can enter your Drugs and Doctors so we can work together to find the best plan to match.
Can compare different Prescription Drug plans in YOUR area with an agent over the phone, in-person or by using our/your personalized web site at:
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Call us to help you understand your options.
To Review Your Best Options, can Call / Text at 346-567-8300, E-mail or Schedule an Appointment at the top right of this web site.
Getting Financial Help for Prescriptions - "Extra Help/LIS"
In 2025, the income limit for Medicare's Extra Help (LIS) program is $22,590 for an individual and $30,660 for a married couple. The resource limit is $17,600 for an individual and $35,130 for a married couple. Those approved might qualify for Extra Help from Medicare to pay their Part D premiums and limit out-of-pocket drug costs. Can also help eliminate Part D Drug Deductibles and/or Late Enrollment Penalties.
- Note: Resources includes things like bank accounts, stocks, bonds, mutual funds/investment accounts and real estate (excluding primary residence). LIS is short for Low Income Subsidy.
See Medicare's instructions on applying for Extra Help (LIS):
https://www.ssa.gov/medicare/part-d-extra-help
This information was obtained from www.medicare.gov, thru Google