Out-of-Pocket Protection

Part D includes important protections that can reduce the impact of high prescription costs. Your exact out-of-pocket amount depends on the plan’s deductible, copays/coinsurance, formulary, pharmacy network, and whether your drugs are covered.

Tip: Always confirm your medications are on the formulary and priced correctly at your preferred pharmacies.

Premiums & Plan Choices

• Premiums vary by plan and by service area (ZIP code).
• Drug tiers, pharmacy networks, and formularies can change each year.
• Comparing plans annually can help avoid surprises at the pharmacy counter.

Plan Rules That Matter

• Formulary coverage: your drug must be covered by the plan.
• Utilization rules: prior authorization, step therapy, and quantity limits can apply.
• Preferred pharmacies: can significantly change your copays.

Late Enrollment Penalty

If you go 63+ days without Part D or other creditable prescription coverage after you’re eligible, Medicare may add a penalty to your premium when you enroll.

Keep your creditable coverage notice (from employer/union/VA, etc.) as proof.

Creditable Coverage

Coverage is “creditable” if it’s expected to pay, on average, at least as much as standard Medicare Part D. If you have creditable coverage, you can usually delay Part D without penalty.

Extra Help (Low-Income Subsidy)

If you qualify for Extra Help, your premiums, deductibles, and copays may be reduced significantly. Eligibility is based on income and resources and can change year to year.