✅ Medicare Part D (Prescription Drug Coverage) Explained
Your Local Medicare Resource in Augusta, GA
Helping you understand your options and avoid costly surprises.
📌 Tabs Overview:
- Who Qualifies
- What the Cost Is
- When Can One Sign Up
- Possible Changes in 2026
🧍♂️ Tab 1: Who Qualifies for Medicare Part D
To enroll in a Medicare Part D plan, you must:
✅ Be enrolled in Medicare Part A and/or Part B
✅ Live in the plan’s service area (coverage options vary by ZIP code — Augusta, GA has multiple plans available)
✅ Enroll during a valid enrollment period
You can get Part D in one of two ways:
- Stand-alone Part D plan (PDP) – for those with Original Medicare or Medigap
- Medicare Advantage with drug coverage (MAPD) – an all-in-one plan
💡 Note: If you have other creditable drug coverage (like VA or employer coverage), you may delay enrollment without penalty.
💲 Tab 2: What the Cost Is for Part D
Costs vary by plan, income, and pharmacy network. Here’s a breakdown of what to expect:
🔹 Monthly Premium:
- Varies by plan and region — in Augusta, GA, plans can start as low as $0–$15/month
- Higher-income individuals may pay an IRMAA surcharge (same income tiers as Part B)
🔹 Deductible (2025):
- Up to $545 (plans can waive or lower this)
🔹 Copays & Coinsurance:
- After your deductible is met, you’ll pay a copay or % of drug cost
- Tiered pricing (Generic vs. Brand vs. Specialty drugs)
🔹 Coverage Stages:
- Initial Coverage: Pay cost-share until total drug cost reaches $5,030
- Coverage Gap (Donut Hole): Pay up to 25% of drug cost
- Catastrophic Coverage: You pay no more than 5%, or fixed small amounts
💡 Many plans partner with specific pharmacy networks. I can help you find the most cost-effective options near you.
📅 Tab 3: When Can One Sign Up for Part D
Like other parts of Medicare, Part D has specific enrollment windows:
🟢 Initial Enrollment Period (IEP)
- 7-month window around your 65th birthday
🔄 Annual Enrollment Period (AEP)
- October 15 – December 7
- Switch, drop, or enroll in a new drug plan
- New coverage starts January 1
🔄 Medicare Advantage Open Enrollment (if enrolled in an MA plan)
- January 1 – March 31: You can switch to a different MA plan or go back to Original Medicare and add a Part D plan
🟡 Special Enrollment Periods (SEP)
Available if:
- You move out of your plan’s area
- You lose other creditable drug coverage
- You enter or leave a nursing home
⚠️ Late Enrollment Penalty:
- If you go 63 days or more without creditable drug coverage, you'll pay a permanent monthly penalty added to your premium.
🔮 Tab 4: Possible Changes in 2026
While final numbers come out later this year, here’s what may change or continue in 2026:
💊 1. Ongoing Prescription Drug Reform
- $2,000 annual out-of-pocket cap will take effect in 2025 and continue in 2026
- This is a major cost-saving for those on expensive medications
📉 2. Insulin Cost Caps
- Plans must continue offering insulin at $35/month or less
📋 3. Negotiated Drug Pricing Begins
- Medicare can begin negotiating prices for high-cost drugs in 2026
- May reduce prices for select brand-name medications
📈 4. Premium Adjustments
- Monthly premiums and deductibles may shift slightly
🛑 I stay on top of these updates so my clients in Augusta don’t have to guess — I’ll help you evaluate your Part D choices every year during AEP.