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Medicare Annual Enrollment Period Guide
Comparing Prescription Drug Plans (Part D) During the Medicare Annual Enrollment Period (AEP)
Whether you have a Medicare Prescription Drug plan (Part D) or have prescription coverage through a Medicare Advantage plan, it’s extremely beneficial to review your plan each year to ensure it still includes the benefits you need at a price you can afford. Plans can vary by cost, coverage amount, and quality, so it’s important to compare your options during the Medicare Annual Enrollment Period.
Prescription Drug Plan Costs
Even when you have Medicare Part D coverage, you are still responsible for some out-of-pocket costs. These costs will vary depending on your plan and whether or not you receive Medicare Extra Help, but here are some costs to keep in mind when it comes to your plan.
- Monthly Premium: In addition to a Medicare Part B premium, you will be responsible for a monthly fee for your prescription drug plan as well.
- Yearly Deductible: This is the amount you must pay before your plan begins to pay its share of your covered drugs. Some drug plans don’t have a deductible.
- Copay/Coinsurance: This is the amount you pay for each of your prescriptions after you’ve paid the deductible (if you have a deductible). Some drug plans have varying levels or “tiers” of coinsurance or copayments with different costs for different types of prescriptions.
| Part D Copay Tiers | |||
|---|---|---|---|
| Tier 1 | Tier 2 | Tier 3 | Tier 4 |
| Generic | Preferred | Non-preferred | Specialty |
 | | | |
| The least expensive drugs your plan covers, including all generic drugs and select brand names | Brand-name drugs that have proven to be the most effective in their class | Drugs considered non-preferred (brand names that are not the “most effective”) as well as preferred specialty drugs | The most expensive drugs are classified as brand-name, specialty, and not preferred |
- Coverage Gap: The coverage gap (also known as the “donut hole”) means there’s a temporary limit on what the drug plan will cover for drugs. The coverage gap begins after you and your drug plan have spent a certain amount on covered drugs. Not everyone enters the coverage gap, but these amounts all count toward you getting out of it:
Yearly deductible, coinsurance, and copays
The discount you get on brand-name drugs in the coverage gap
What you pay in the coverage gap and what you paid in initial coverage
These amounts don’t count toward getting you out of the coverage gap:
Your Medicare drug plan premium
What you pay for non-covered drugs
What’s paid by other insurance and what your Plan D pays
- Catastrophic Coverage: Once you get out of the coverage gap, you automatically receive catastrophic coverage, which means you only pay a small coinsurance or copay for covered drugs for the remainder of the year.
- Late Enrollment Penalty: If you don’t join a Medicare drug plan when you’re first eligible, and you don’t have other creditable prescription drug coverage or receive Extra Help, you could potentially pay a Part D late enrollment penalty.
Amount of Prescription Drug Plan Coverage
It can be extremely beneficial to take the time to compare different plans available to you to ensure yours meets your needs and your budget. Medicare drug plans will vary in what they cover, and some can have special rules. Take the time to review the formulary—the list of drugs that your plan covers—and rules to ensure you understand the amount of coverage you have and any stipulations tied to it.
Quality of Your Prescription Drugs
In addition to the costs and amount of coverage, you might also want to review quality ratings before making any final decisions. Medicare.gov gathers information from member satisfaction surveys, plans, and healthcare providers to give overall performance ratings to plans. These ratings can be found on the Medicare Plan Finder on Medicare.gov.
Convenience of Payment and Pickup of Prescription Drugs
It’s beneficial to double-check that the pharmacy where you order your medications is in your plan’s network. Some plans will charge lower copays or coinsurance amounts at one location over another, and some even offer mail-order programs to have your prescriptions sent directly to your home. Note: Even if you do not intend to change plans during AEP, be sure to check that your pharmacy is still in your plan’s network next year. Plans can change from year to year.
Explore the Medicare Annual Enrollment Period Guide for 2026 Coverage
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