Medicare Part D Prescription Drug Plans
Affordable prescription coverage that works with your Medicare plan
Medicare Part D helps cover the cost of prescription drugs. If you have Original Medicare, you'll need a separate Part D plan. Most Medicare Advantage plans include drug coverage, but you can still choose a standalone Part D plan if needed. Don't wait - late enrollment penalties apply if you go without creditable coverage.
⚠️ Avoid the Late Enrollment Penalty
If you don't have Part D or other creditable prescription drug coverage when you're first eligible, you may pay a penalty for as long as you have Medicare prescription drug coverage. The penalty in 2025 is 1% of the national base premium ($37.80) for each month you delayed enrollment.
How Part D Coverage Works: The Four Phases
Understanding Your Drug Coverage Throughout the Year
Part D coverage changes as your spending increases. Here's what to expect at each phase:
Deductible Phase
You pay full cost until you reach your plan's deductible (up to $590 in 2025). Some plans have $0 deductible.
Initial Coverage
You pay copays or coinsurance for your drugs until your total spending reaches $5,030 in 2025.
Coverage Gap
You pay 25% for brand drugs and generics until your out-of-pocket costs reach $8,000 in 2025.
Catastrophic Coverage
You pay the greater of 5% coinsurance or $4.50 for generics/$11.20 for brand drugs for the rest of the year.
Choose the Right Plan Type for You
Basic Part D Plans
Standard coverage with predictable costs for common medications
- Lower monthly premiums
- Standard Medicare formulary
- Good for generic medications
- Available deductible options
Enhanced Part D Plans
Additional benefits beyond standard Medicare requirements
- Expanded drug formularies
- Coverage in the gap phase
- Lower or $0 deductibles
- Preferred pharmacy networks
Medicare Advantage with Rx
All-in-one plans that include medical and prescription coverage
- Combines medical and drug coverage
- Often includes extra benefits
- Local doctor networks
- Coordinated care management
When Can You Enroll in Part D?
Initial Enrollment Period
7 months around your 65th birthday (3 months before, your birthday month, and 3 months after).
Annual Open Enrollment
October 15 - December 7 each year. Make changes that take effect January 1st of the following year.
Special Enrollment Periods
Qualify due to moving, losing creditable coverage, or other qualifying life events.
Medicare Advantage OEP
January 1 - March 31 for those in Medicare Advantage plans to switch to Original Medicare + Part D.
Popular Southwest Florida Pharmacy Networks
Major Chain Pharmacies
CVS, Walgreens, Publix, Winn-Dixie, and Walmart are widely available throughout Lee, Collier, Charlotte, and Sarasota counties.
Preferred Networks
Many plans offer lower copays at preferred pharmacies. We'll help you find plans that work with your favorite local pharmacy.
Mail Order Options
90-day supplies for maintenance medications often cost less through mail order pharmacies - perfect for snowbirds.
Local Independent Pharmacies
Many smaller, local pharmacies participate in Medicare Part D networks and offer personalized service.
Why Choose Southwest FL Medicare for Part D Plans?
Formulary Analysis
We review your current medications against each plan's formulary to ensure your drugs are covered at the best possible cost.
Cost Projections
We calculate your total annual costs including premiums, deductibles, and drug expenses to find the most affordable option.
Local Pharmacy Knowledge
We know which Southwest Florida pharmacies work best with each plan and can help you maintain relationships with trusted local pharmacists.
Extra Help Applications
We assist with Low Income Subsidy applications that can dramatically reduce your prescription costs if you qualify.
Annual Review Service
Every fall, we review your plan to ensure it still meets your needs and help you make changes during open enrollment if beneficial.
Ongoing Support
Questions about coverage, prior authorizations, or appeals? We're here to help you navigate your plan throughout the year.
Key Factors When Choosing a Part D Plan
Check Your Drug Formulary
Make sure all your current medications are covered. Plans can change their formularies each year, so annual reviews are essential.
Consider Total Annual Costs
Don't just look at monthly premiums. Factor in deductibles, copays, and the coverage gap to understand your true annual expenses.
Verify Pharmacy Networks
Ensure your preferred pharmacy participates in the plan's network. Preferred pharmacies often offer lower copays than standard network pharmacies.
Understand Prior Authorizations
Some drugs require prior approval. Check if your medications have restrictions and understand the approval process.
Frequently Asked Questions
Do I need Part D if I have good drug coverage now?
If your current coverage is "creditable" (as good as Medicare's), you can delay Part D enrollment without penalty. However, verify this annually as coverage can change.
Can I switch Part D plans every year?
Yes! During Annual Open Enrollment (October 15 - December 7), you can switch to any available Part D plan in your area without health questions.
What if my drug isn't covered by my plan?
You can request an exception for coverage or appeal the decision. Your doctor may need to provide documentation showing medical necessity for the specific drug.
How does Extra Help work?
Extra Help is a federal program that helps pay Part D costs for those with limited income and resources. It can reduce or eliminate premiums, deductibles, and copays.
Find the Perfect Part D Plan for Your Medications
Stop overpaying for prescriptions! Our licensed agents will analyze your current medications and find the most cost-effective Part D plan available in Southwest Florida. Get personalized recommendations that could save you hundreds of dollars each year.
Get Your Free Part D Analysis