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How to live with the Medicare Part D plan that you have selected.

Perhaps one of the greatest challenges - after selecting the "optimal" Medicare Part D plan - is to prepare or budget for the use of the plan. Many Seniors appear to have developed a budget with respect to their medication costs - allocating a certain portion each month for prescription costs. For some people, the new Medicare Part D may take additional planning because the prescription costs (depending on the plan) may vary greatly from month, simply due to their choice of Medicare Part D coverage.

For instance, let us assume that someone has selected a Medicare Part D plan with a $15 per month premium, a $590 deductible and 25% Coinsurance (you pay 25% of the retail price of drugs) and their average monthly retail cost of medication is $589. Their monthly costs would be as follows:

January: $15 (premium) + $589 (medication costs toward deductible) = $604 total costs.
Feb-Sept: $15 (premium) + $147.25 ($589 RX costs * 25% coinsurance) = $162.25 total monthly costs
Oct-Dec: $15 (premium) + $147.25 ($589 RX costs * 25% coinsurance -- you receive the 75% Donut Hole drug discount.) = $162.25 total monthly costs.

This person would meet their deductible in the first month of coverage (January). Starting in February, this person would pay 25% of $589 or $147.25 per month for medication. This Co-Insurance coverage would continue until the Donut Hole is reached: in Month 9 ($2,000 / $589) or the end of September. Starting in October and continuing through December, the Medicare beneficiary will be again responsible for 100% of their medication costs or $589 per month.

Therefore, this person must be prepared for an initial period (January) where they would pay 100% of their own medication - a second period where they received Co-Insurance coverage - and a third period where they must once again pay 100% of their medication costs. In addition, this person would also be responsible for the monthly premiums for this Medicare Part D plan.

Our suggestion is to plan out your 2025 prescription drug budget now so that you can plan for highs and lows in your prescription drug spending. Once again the key is to eliminate or, at least minimize, the surprises in 2025 and beyond.


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  • Benefits, formulary, pharmacy network, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Our PDPCompare.com and MACompare.com provide highlights of annual plan benefit changes.
  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
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  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
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  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
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