MEDICARE SERVICES
Prescription Drug Plans (Medicare Part D)
Your Prescription Coverage Can Change Every Year.
Your medications are personal. Your prescription coverage should be reviewed with the same care. We’ll help you understand Medicare Part D, compare available plans, and consider your medications, preferred pharmacies and potential costs before you choose.
MEDICARE SERVICES
- Turning 65 & New to Medicare
- Medicare Advantage
- Medicare Supplement
- Prescription Drug Coverage
- Annual Medicare Reviews
- Medicare & Medicaid
- Medicare Support & Advocacy
Why Prescription Drug Guidance?
- Review your current medications
- Compare available Part D plans
- Check drug formularies and tiers
- Review preferred pharmacy options
- Understand premiums and out-of-pocket costs
- Check for coverage restrictions
- Review changes before the next plan year
Before Choosing a Plan
- Medication names and dosages
- Preferred pharmacies
- Brand-name and generic prescriptions
- Monthly premium
- Deductible and copayments
- Pharmacy network
- Coverage restrictions
- Expected annual medication costs
Need Help Reviewing Your Prescriptions?
Your current plan may not offer the same coverage or costs next year. We’ll help you understand the details and compare available options.
UNDERSTANDING PRESCRIPTION COVERAGE
What Is Medicare Prescription Drug Coverage?
Medicare Part D helps cover outpatient prescription medications through private insurance plans approved by Medicare.
You can generally get Part D coverage through a standalone Prescription Drug Plan (PDP) alongside Original Medicare, or through a Medicare Advantage plan that includes prescription drug coverage.
Plans differ in the medications they cover, their pharmacy networks, premiums, deductibles and the amount you pay when filling prescriptions. That’s why it’s important to review the specific plan rather than choosing based on its monthly premium alone.
Important to know
A plan that covered your prescriptions last year may have different costs, coverage rules or pharmacy arrangements this year. Review your coverage every year before deciding whether to keep or change your plan.
How prescription drug coverage works
Understanding Your Part D Coverage
Review Your Medications
List your prescriptions, dosages and how often you take them.
Compare Available Plans
Review which plans cover your medications and the costs that may apply.
Check Your Pharmacy
Confirm whether your preferred pharmacy participates and how its costs compare.
Review Before Enrolling
Check the plan's coverage, restrictions and expected costs for the coming year.
FORMULARIES & DRUG TIERS
Is Your Medication Covered?
Every Part D plan has a formulary a list of prescription drugs it covers. Even when a medication is included, the amount you pay can vary depending on its assigned tier and the plan’s rules.
We’ll help you review your medications against available plan formularies and identify details worth checking before enrollment.
What we'll check
- Medication coverage: Is each prescription included on the plan's formulary?
- Drug tiers: What cost-sharing applies to each medication?
- Prior authorization: Does the plan require approval before covering a drug?
- Step therapy: Must you try another medication first under the plan's rules?
- Quantity limits: Are there limits on the quantity covered within a given period?
- Alternatives: If a medication isn't covered, what questions should you discuss with your prescriber?
Your health decisions stay with you and your healthcare provider.
Your pharmacy matters
Is Your Preferred Pharmacy in the Plan's Network?
A prescription plan’s pharmacy network can affect how much you pay. Some plans offer different cost-sharing at preferred pharmacies, and a pharmacy that participates in one plan may not have the same status with another.
Before enrolling, we'll help you consider:
- Preferred pharmacy: Does your usual pharmacy participate in the plan?
- Preferred cost-sharing: Does the plan offer lower cost-sharing at particular pharmacies?
- Mail-order options: Could home delivery be convenient, and what would it cost under the plan?
- Access and convenience: Can you reliably obtain your regular medications where and when you need them?
But these factors don't automatically mean Medigap is the right choice. Your coverage, healthcare needs, budget and enrollment situation all matter.
BEYOND THE MONTHLY PREMIUM
What Can a Prescription Drug Plan Cost?
Your total prescription expenses depend on the plan you select, the medications you take, your pharmacy and the plan’s cost-sharing rules.
Don't Choose Your Plan Based on Premium Alone
A lower-premium plan may not have the lowest overall cost for your particular medications. Compare the premium, deductible, drug tiers, pharmacy costs and other coverage rules together. Plan costs and coverage can change each year.
A useful 2026 Medicare update
For 2026, the annual out-of-pocket cap for covered Part D prescription drugs is $2,100. The cap does not mean every medication is covered, and plan premiums remain separate. Eligible beneficiaries may also qualify for programs that help reduce prescription costs.
A useful 2026 Medicare update
For 2026, the annual out-of-pocket cap for covered Part D prescription drugs is $2,100. The cap does not mean every medication is covered, and plan premiums remain separate. Eligible beneficiaries may also qualify for programs that help reduce prescription costs.
A payment option for prescription expenses
Could the Medicare Prescription Payment Plan Help?
This voluntary, no-fee program lets you spread out-of-pocket costs for covered Part D medications across monthly payments throughout the year.
It doesn’t reduce your total drug costs or replace your plan premium. Monthly payments may vary, so check with your plan to see if it suits your needs.
MEDICARE ADVANTAGE
Part C
- Provided by private insurance companies
- Includes Part A and Part B benefits
- May have provider networks
- Often includes prescription drug coverage
- May include additional benefits
MORE THAN AN AGENT
Don't Just Choose an Agent.
Choosing a Medicare Supplement plan is only part of the journey.
At Pro Compare Medicare, we're here to educate, compare and support you, not simply move you through an enrollment process.
We'll help you understand what you're choosing, why it may fit your situation and what to consider before moving forward.
Who Should Consider It?
Could a Part D Plan Be a Good Fit?
A Medicare Part D plan may be worth exploring if you need prescription drug coverage or want to review whether your current coverage still meets your needs.
Taking Prescription Medications
Review plans that cover your current medications and compare potential costs.
Enrolled in Original Medicare
A standalone Part D plan can provide prescription drug coverage alongside Original Medicare.
Reviewing Current Coverage
Compare formularies, premiums, deductibles, copayments, and pharmacy networks before choosing.
Looking Ahead to Next Year
Review your coverage annually, as plan costs, covered medications, and pharmacy arrangements can change.
Keep in Mind:
Not every plan covers every medication, and the lowest monthly premium may not mean the lowest overall cost. Your prescriptions, preferred pharmacy, and budget all matter.
Medicare Supplement Questions
Frequently Asked Questions
What is Medicare Part D?
Medicare Part D is prescription drug coverage offered through private plans approved by Medicare. It can be purchased as a standalone plan or included in many Medicare Advantage plans.
Do I need a separate Part D plan if I have Medigap?
Medigap policies generally do not include prescription drug coverage. If you have Original Medicare and Medigap and want Medicare prescription coverage, you generally need a separate Part D plan.
Are all prescription drug plans the same?
No. Plans can differ in formularies, pharmacy networks, premiums, deductibles, drug tiers and coverage rules.
Will my medications be covered?
It depends on the plan’s formulary and any applicable coverage restrictions. Review each medication against the specific plan before enrolling.
Can I keep using my preferred pharmacy?
That depends on the plan’s pharmacy network and cost-sharing arrangements. Check whether your pharmacy participates and whether preferred pharmacy pricing applies.
Why should I review my drug plan every year?
Plans may change their premiums, formularies, pharmacy networks and cost-sharing from year to year. Reviewing your coverage helps you understand how those changes may affect you.
What happens if I delay Part D enrollment?
If you go without Part D or other creditable prescription drug coverage for 63 consecutive days or more after your initial enrollment opportunity, a late-enrollment penalty may apply unless an exception applies.
What if I can't afford my medications?
You may qualify for assistance such as Extra Help or other programs. Eligibility varies, so review the available support options for your situation.
Can I change my prescription drug plan?
Eligible beneficiaries can generally make changes during the Annual Election Period, and certain circumstances may provide other enrollment opportunities.
