When it comes to Medicare, understanding your options is key to avoiding costly mistakes—especially when it comes to prescription drug coverage.
Medicare Part D, often misunderstood and overlooked, is a crucial part of your healthcare coverage. Whether you’re already enrolled in Medicare or just turning 65, knowing how Part D works and why you need it can protect your health and your wallet.
At Ed McMahan Medicare Insurance in Prescott, AZ, we make understanding Medicare easy and personalized. Let’s break down what Part D is, how it works, and how Ed can help you choose the right plan for your needs.
What Is Medicare Part D?
Medicare Part D is the prescription drug coverage portion of Medicare. It helps cover the cost of your medications, including:
- Brand-name and generic drugs
- Medications you take regularly
- Some vaccines and specialized treatments
Part D is offered by private insurance companies that are approved by Medicare. This means there’s no single “standard” plan—plans vary in cost, coverage, and pharmacy networks. If you have Original Medicare (Parts A & B), you’ll need to enroll in a standalone Part D plan to get prescription coverage.
If you enroll in a Medicare Advantage Plan (Part C), drug coverage is often included—but not always. That’s where a local Medicare expert like Ed McMahan becomes essential.
What Does Part D Cover?
Each Part D plan has its own drug formulary—a list of covered medications, usually arranged in tiers
- Tier 1: Preferred generics (lowest cost)
- Tier 2: Generic drugs
- Tier 3: Preferred brand-name drugs
- Tier 4: Non-preferred drugs
- Tier 5: Specialty medications (highest cost)
Plans must cover drugs in key categories, such as:
- Cancer treatment
- HIV/AIDS medications
- Antidepressants
- Seizure medications
- Immunosuppressants
Working with a local broker ensures your medications are covered under the most cost-effective plan.
How Do Part D Plans Work?
Here’s a simplified breakdown of how Part D costs are structured:
- Monthly Premium
You pay a premium to your chosen Part D plan provider. Prices vary by plan and location. - Annual Deductible
Some plans have a deductible—the amount you pay out-of-pocket before your coverage kicks in. - Copayments and Coinsurance
Once the deductible is met, you pay a copay or percentage for each drug, depending on its tier. - Coverage Gap (“Donut Hole”)
After you and your plan spend a certain amount (around $5,030 in 2025), you enter the coverage gap. You’ll pay up to 25% of drug costs until you reach the catastrophic threshold. - Catastrophic Coverage
After spending approximately $8,000 out-of-pocket, you enter catastrophic coverage, and your costs significantly drop.
What Happens If You Don’t Enroll in Part D?
Many people think, “I’m not taking medications right now so why should I enroll ?
Here’s why: If you don’t enroll when you’re first eligible and don’t have creditable coverage (like employer drug coverage), you’ll face a lifetime late enrollment penalty. This penalty is added to your monthly premium permanently. The longer you go without coverage, the higher the penalty.
Protect your future and your finances—even if you’re healthy now, enrolling early is the smarter move.
How Ed McMahan Helps You Choose the Right Part D Plan
Part D can be overwhelming. Each plan has different:
- Premiums
- Formularies
- Pharmacy networks
- Deductibles and copays
Ed McMahan takes the guesswork out of the process by:
- Reviewing your current medications
- Finding plans that cover your prescriptions at the lowest cost
- Checking your preferred pharmacy network
- Making sure you avoid late penalties or coverage gaps
Ed McMahan Medicare Insurance is a trusted local source for personalized Medicare guidance. Whether you’re new to Medicare or reviewing your current plan.
📌 Contact Information
Ed McMahan Medicare Insurance
📍 3623 Crossings Dr, Ste 277, Prescott, AZ 86305
📞 (928) 379-0172
📧 edmcmahan2020@gmail.com
🛡️ Why You Need Part D – Even If You’re Healthy Today
Here are five compelling reasons to enroll in Medicare Part D:
- Avoid Penalties
Late enrollment penalties are permanent and grow over time. Enroll when you’re first eligible—even if you don’t take medications yet. - Protect Against Future Costs
Health needs change. If a doctor prescribes a high-cost medication next month, you’ll wish you had coverage in place. - Plan for the Unexpected
Accidents and illnesses can happen anytime. A hospital discharge or new diagnosis may require costly medications. - Peace of Mind
Know you’re covered and prepared—not scrambling during a health crisis. - It’s Affordable with the Right Guidance
Plans vary widely in cost. Ed helps you find one that fits your budget without sacrificing coverage.
Frequently Asked Questions (FAQs)
- Do I need a Part D plan if I have Original Medicare?
Yes. Original Medicare doesn’t cover prescription drugs. You’ll need to enroll in a standalone Part D plan. - What if I already have prescription drug coverage?
If you have creditable coverage (like VA or employer drug coverage), you may not need Part D yet—but it’s best to speak with Ed to avoid penalties later. - Can I change my Part D plan later?
Yes. You can change plans during Medicare Open Enrollment (October 15–December 7) each year.