Prescription Drug Coverage
(Part D)
Because Medication Costs Add Up Fast
Medicare Part D is the part of Medicare that helps cover the cost of prescription drugs. Whether you take one medication or several, Part D is an essential piece of your overall Medicare strategy. It protects you from high pharmacy bills and ensures you’re not paying full price for medications out of pocket.
Part D plans are offered by private insurance companies approved by Medicare. They vary in terms of pricing, drug coverage, and pharmacy networks, but all plans must follow rules set by the federal government. You can get Part D as a standalone plan (if you’re using Original Medicare or Medigap), or it may be included in a Medicare Advantage plan (Part C).
If you don’t enroll in Part D when you’re first eligible, and you don’t have other creditable drug coverage, you could face a permanent late enrollment penalty added to your premium. That’s why it’s important to make a timely decision, even if you don’t currently take prescriptions.
Why It Matters
Even if you don’t take many prescriptions now, the need for medications tends to increase with age. Medicare Part D ensures you have access to the medications you need at a price you can manage, without draining your savings or going without care. Without a Part D plan, you’ll pay full retail price for your prescriptions, many of which can cost hundreds or even thousands of dollars per month. On top of that, if you delay enrolling when you're first eligible, you could face a lifetime late enrollment penalty added to your monthly premium. That penalty grows the longer you wait. Beyond the financial protection, Part D plans offer access to broad pharmacy networks and tiered drug pricing, giving you the opportunity to lower costs even further by selecting generic or preferred brand-name options. In short, even if you’re healthy today, Part D is insurance against the costs of tomorrow, and a critical piece of a complete Medicare strategy.
The Four Stages Of A Part D Plan
1. Annual Deductible - You pay 100% of your prescription costs until you reach your plan’s deductible. In 2025, the deductible can be up to $590. Some plans waive the deductible for lower-tier medications.
2. Initial Coverage - Once the deductible is met, your plan starts helping with costs. You pay a copay or coinsurance, based on the drug’s tier. Plans typically have formulary tiers: generics are less expensive, brand-name and specialty drugs cost more.
3. Coverage Gap (“Donut Hole”) - After total drug costs (what you + the plan have paid) hit $5,030, you enter the gap. You pay 25% of the cost for both brand-name and generic drugs. This phase continues until your out-of-pocket costs reach the catastrophic threshold.
4. Catastrophic Coverage - Once your out-of-pocket spending reaches $8,000, your plan covers most of the remaining costs. You’ll pay only a small copay or coinsurance for the rest of the year.
Choosing The Right Plan
The right Part D plan depends on one thing: your prescriptions. Every plan has its own formulary (drug list), pricing tiers, and preferred pharmacies. What works well for someone else might not work for you. At Platinum Shield, we help you compare plans based on the medications you actually take, where you prefer to fill them, and your budget. That way, you avoid overpaying, or enrolling in a plan that doesn’t cover what you need.
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© 2025 Platinum Shield Insurance. All rights reserved. As a national Medicare brokerage, we work with multiple carriers to provide comprehensive plan options. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.