How Do Prescription Drug Plans Work?

Here is some important information you need to know about owning a prescription drug plan:


  • Annual Deductible — There is a deductible you must pay for a Part D plan. Your deductible may be different, or waived entirely, but the max amount you can be charged is $415 in 2019. You will pay a discounted price for your medications until you have satisfied the deductible. After that, you can begin the initial coverage.

  • Initial Coverage — During initial coverage, you pay a copay for your medications based on your plan’s formulary. Each prescription drug plan separates its medications into tiers. Each tier has a copy amount for which you are responsible. They are typically separated by generic drugs, preferred name brands, even more specialized medications, etc. In 2019, the initial coverage cap is $3,820. Once you and the insurance company together have paid this amount, then you enter the coverage gap.

  • The Coverage Gap – During the coverage gap, you will still generally have significant discounts for generic medications. Typically, you will pay 25% for name brand medications and 37% for generics. Your gap spending will continue until you have paid $5100 out of your own pocket in 2019.

  • Catastrophic Coverage – If you spend past the coverage gap, your plan will begin to pay 95% of the costs of your formulary medications for the rest of the year.

How would I enroll?

Fill out the form and we will be in contact soon or press the "Click to Call" button above to call us today!

Check your own plan?

You will be taken to another website. You will need to choose "Medicare Part D plans" after entering your zip code and clicking on "see plans and prices."


See Which Plans Are In Your Area Today

We do not offer every plan available in your area. Currently we represent 23 organizations nationwide which offer 1,779 products nationwide. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

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Price Services Group (L.L.C.) is NOT Endorsed by or Affiliated with Medicare or ANY Government Program.

We contract with multiple insurance carriers so we have numerous plan options available to you. However, we may not offer every plan available in your area. Also, keep in mind that while we may have multiple plan options available to you, we may not offer every plan available in your area. Any information we provide is limited to those plans we do offer.

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