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Prescription Drug Plans
(Part D)
Medicare Part D is the portion of Medicare that helps cover prescription drug expenses. It’s offered through private insurance companies approved by Medicare and is available either as a standalone plan (for those with Original Medicare and/or a Medigap plan) or bundled within certain Medicare Advantage plans.
While drug coverage may seem optional, skipping Part D can lead to significant out-of-pocket costs and a permanent late enrollment penalty. Even if you’re not currently taking medications, enrolling in a plan when you’re first eligible helps ensure that you’re protected in the future—when prescription needs are likely to grow.
Each Part D plan comes with its own formulary (drug list), pricing tiers, and pharmacy network, so choosing the right plan requires more than just checking a box. At Walek Insurance, we evaluate your prescriptions and help you select a Part D plan that offers cost-effective, reliable coverage—with no guesswork.
Because Medication Costs Aren't Optional
Why Part D Matters
For many people, prescription drugs are a critical part of ongoing care, whether managing chronic conditions, recovering from surgery, or simply maintaining long-term health. Without a Part D plan, even routine prescriptions can result in unexpected, high out-of-pocket costs.
But it’s not just about the immediate expense. Delaying enrollment in Part D without other creditable drug coverage can trigger a lifetime late enrollment penalty, permanently increasing your monthly premium.
Even if you're not currently taking any medications, having Part D coverage in place ensures you're protected against future health events and gives you access to a broad network of pharmacies and coverage for both generic and brand-name drugs. With drug prices continuing to rise, Part D is not just a safety net, but it’s a smart investment in your long-term financial health.
At Walek Insurance, we help you choose a plan that aligns with your current prescriptions, pharmacy preferences, and budget, so you’re covered when it matters most.
The Structure of Part D
Medicare Part D plans may vary by provider, but most follow the same basic structure. Knowing how the plan phases work helps you anticipate your costs and make informed decisions.
1. Annual Deductible
You pay 100% of your drug costs until you meet the plan’s deductible. In 2025, this can be up to $590, depending on the plan.
2. Initial Coverage Phase
After the deductible, your plan begins sharing the cost. You pay a copay or coinsurance for each prescription, based on the plan’s drug tier system (generic, preferred brand, non-preferred brand, specialty, etc.).
3. Coverage Gap
Once total drug costs (including what you and your plan have paid) reach a certain limit (around $5,030 in 2025), you enter the coverage gap. You’ll pay a higher percentage of drug costs until you reach the catastrophic threshold.
4. Catastrophic Coverage
After hitting the annual out-of-pocket maximum (around $8,000 in 2025), you pay significantly reduced costs—usually a small copay or a 5% coinsurance—for the rest of the year.
Each plan's details—formulary, pharmacy network, and pricing—can significantly affect your total cost. At Walek Insurance, we analyze your medications to help you select a plan that balances affordability, access, and reliability.
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© 2025 Walek 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.