Medicare Part D: Prescription Drug Plans

Some insurers, like Medical Mutual, include Part D coverage in their Medicare Advantage plans. Learn more about Medical Mutual’s Medicare Advantage with prescription drug plans.

Part D Coverage Stages

With Medicare Part D, there are three coverage stages that affect the cost of your drug. While the three coverage stages are standard for all Part D plans, your actual costs will vary depending on:

• The drugs you use
• The plan you choose
• Whether you go to a pharmacy in your plan's network
• Whether the drugs you use are on your plan's formulary
• Whether you get Extra Help paying your Medicare Part D costs

Here are some costs you can expect with Medicare Part D Plans:

Prescription Drug Deductible

If your plan has a deductible, you pay 100% of your prescription drug costs until it is met.

Initial Coverage Cost-sharing

After you meet your deductible, you pay a flat rate (called a copayment or copay) or a percentage (called coinsurance) of the total amount, usually when you pick up a prescription. 

Catastrophic Coverage

After you reach your plan’s maximum out of pocket amount, you only pay a small copayment or coinsurance amount for prescription drugs. For the rest of that year, your Part D plan covers the remaining costs. 

To learn more about the Part D coverage stages and coverage gap, contact the Centers for Medicare & Medicaid Services at 1-800-633-4227 (TTY:1-877-486-2048 for hearing impaired).