Vance Insurance Group
Medicare Part D
Medicare Part D
When it comes to Medicare, one size definitely doesn't fit all. What works for your neighbor may not be the best fit for you. Vance Insurance Group is here to help you understand your needs, explain your options and make Medicare as simple as possible to understand.
Medicare Part D
Medicare Part D provides coverage for prescriptions and some vaccines
You can get drug coverage with a stand-alone Part D plan or as part of a Medicare Advantage plan (Part C)
Part D plans are offered by private insurance companies approved by Medicare. Your choices vary depending on where you live. All prescription drug plans must meet the same basic guidelines created by the federal government. But not all plans are the same.
Every Part D plan has a drug list or formulary, that shows all the brand name and generic drugs it covers
Most formularies categorize drugs into tiers based on how much they cost. Covered drugs and costs vary from plan to plan.
Coverage includes:
Drugs most commonly prescribed for Medicare beneficiaries as determined by federal standards
Specific brand name drugs and generic drugs included in the plans's formulary (list of covered drugs)
Commercially available vaccines like the shingles vaccine, not covered by Part B
Part D costs
You may pay a monthly premium, a deductible, copay and coinsurance. Costs will vary by plan and provider since each plan sets their own premium amounts.
Stand-alone Part D plans change a premium, and the amount will vary based on the plan and provider.
- Some plans may charge a deductible and others don’t. The 2025 annual deductible limit is $590.
- A copay is generally required each time you fill a prescription for a covered drug. Copay amounts vary by plan.
- Some plans may also set coinsurance rates for certain drugs or drug tiers.
Part D coverage has four cost stages
You pay a share of the cost for your drugs in each stage up to a limit. You may not reach all stages. The cycle restarts each year.
Annual Deductible
Initial Coverage
Catastrophic Coverage
You pay for your drugs until you reach your plan's deductible
During this phase, beneficiaries pay 100% of the cost of their prescription medication until the deductible has been reached. The standard deductible for 2025 is $590. However, some plans have a lower (or zero dollar) deductible with a higher premium. Once beneficiaries reach their deductible, they enter the initial coverage period.
You pay a copay or coinsurance, and your plan pays the rest
In this phase, beneficiaries pay 25% of their prescription drug cost, typically in the form of coinsurance or copayments. The part D plan pays 65% of costs, while the drug manufacturer is responsible for 10%. Out of pocket costs (including the Part D deductible, copayments, and coinsurance) are capped at $2000 in 2025. After beneficiaries reach this limit, they enter the catastrophic coverage phase.
You pay nothing for covered medications for the rest of the calendar year
In this phase, the Part D plans pays 60% of drug costs, the drug manufacturer pays 20%, and Medicare pays 20%. Beneficiaries pay nothing for covered medications for the rest of the year.
You pay a small copay or coinsurance amount
you stay in this stage for the rest of the plan year.
Penalty
You could pay an addition 1% of average Part D plan premium for each month you delay enrollment. The penalty is charged every month for as long as you’re enrolled in Part D.
Contact Us
Location:
1200 S Horner Blvd #5046, Sanford NC 27331
Support:
info@vigrp.com
* All information provide will remain confidential.
We do not offer every plan available in your area. Currently we represent five organizations which offer twenty-two products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.”
