Medicare Part D (Prescription Drug Plan, PDP)
Medicare Part D, known as Medicare drug coverage or PDP, helps cover the cost of outpatient prescription drugs. Because coverage is provided by private insurance companies, plan details—including premiums, pharmacy networks, and which drugs are covered—can vary. Federal laws set standard limits and protections for all plans nationwide.
Part D Coverage: Two Options
1. Medicare Drug Plan (Part D, PDP)
- Original Medicare (Part A & B)
- Some Medicare Cost Plans
- Some Medicare Advantage Private Fee-for-Service Plans
- Medicare Medical Savings Account (MSA) Plans
2. Medicare Advantage (Part C, MAPD) or Other Medicare Plans
- Part A, Part B, and Medicare drug coverage (Part D) through a single plan
Part D Costs (2026)
- Annual Deductible: Enrollees pay 100% of their drug costs until the plan’s deductible is reached. No plan’s deductible can be higher than $615.
- Coverage (25% Coinsurance): After the deductible is met, the plan begins to share costs. The enrollee pays approximately 25% for covered drugs.
- Out-of-Pocket: Once out-of-pocket spending reaches $2,100, the enrollee pays $0 for all covered drugs for the rest of the year.
- Monthly Premium: To keep Part D coverage active, a monthly premium is paid to the insurance provider. They do not count toward the $2,100 out-of-pocket cap. Only the money spent at the pharmacy (deductibles and coinsurance) counts toward that limit.
How to Choose & Join a Plan
Beneficiaries are encouraged to review their coverage during the Annual Open Enrollment (Oct 15 – Dec 7) because plans can change.
- Use the Official Plan Finder: Visit Medicare.gov/plan-compare to enter current medications and see which plans offer the lowest total annual cost.
- Check Pharmacy Networks: Confirm if a preferred pharmacy is considered In-Network or Preferred by the plan to ensure the lowest possible copays.
- Bergen County, NJ Residents: Bergen County residents can receive free assistance through AWCA at 201-862-1665 or via email at info@awcanj.org.
*Individuals who don’t enroll when first eligible may have to pay a late enrollment penalty. For more information visit Medicare.gov/avoid late penalties.
Contact
- NJ SHIP (State Health Insurance Assistance Program): Free counseling from state-trained experts
- AWCA provides counseling free of charge (201-862-1665 / info@awcanj.org)
Resources
