What is a Medicare PDP and an MAPD?

Medicare will pay part of the costs of  prescription drug coverage for everyone who enrolls in a plan. How much you pay will depend on which prescription drug plan you choose and whether or not you qualify for Extra Help which helps cover the costs of this coverage.

Medicare Part D Premium

The average nationwide monthly premium for 2025 is $46.50, although plan costs vary depending on the plan you choose and where you live. You will generally only want to choose a plan with low premiums if it also has the lowest overall cost per year, including the costs for the drugs you take.

Medicare Part D Deductible

Remember a plan with a deductible will not pay for your prescriptions until you pay the deductible amount out-of-pocket. The highest deductible a plan can charge in 2019 is $590. Some plans offer $0 deductible and will pay for your prescriptions right away. Other plans may offer a deductible lower than the maximum of $590 like $150 or $250. You will generally only want to choose a plan with a $0 deductible if it also has the lowest overall cost per year, including the costs for the drugs you take.

Copayments and coinsurance

A copayment, or copay, is a fixed dollar amount for your prescriptions. For example, you might have to pay $5 for a generic drug, $25 for a “preferred” brand name drug and $40 for a non-preferred brand name drug.

A coinsurance is a percentage of the price of your prescription. Typically plans require coinsurance for drugs listed in higher tiers like tier 4 and tier 5 drugs. For example, if your prescription costs $350, and your coinsurance is 25%, you will pay $87.50.

It is possible that some of your medications require a fixed copayment and others a coinsurance. Be sure to check the cost of each medication you take with the plan.

You will generally only want to select a plan with low copays or coinsurance if it also has the lowest overall annual cost per year, including the costs for the drugs you take.

What are copay tiers? 

Each plan places the drugs it will pay for in different levels, called tiers. Each tier has its own copay or coinsurance amount. Your drugs may be included in all the plans in your area, but they could be listed on different tiers with different copay amounts.

Each plan will encourage you to use the lowest-cost drug to treat your medical condition. A drug on a lower tier will cost less than a drug on a higher tier.

When does the coverage gap take effect?

As of January 1, 2025 the Medicare Part D coverage gap has been eliminated.

What does initial coverage look like?

Initial coverage is the stage that occurs after you've paid the plan deductible (if your plan has a deductible). During this stage you will pay either a copay or coinsurance for covered medications until you reach $2,000 out-of-pocket for the year.

When does catastrophic coverage take effect?

In Part D, you and the plan you join share the cost of drugs up to the point you've paid $2,000 across all of your medications for the year. The money that you spend is called your out-of-pocket costs. That determines if and when the catastrophic coverage begins. In 2025, catastrophic coverage starts when you have paid $2,000 out of pocket in total drug costs. If your total drug costs are more than $2,000 in 2025, all the Medicare Prescription Drug Plans will cover your drug costs for the rest of that year.

• Once you have spent $2,000 of your own money for drugs in 2025, you would then pay $0 of the cost of your covered drugs for the rest of the calendar year.
• There is no cap or limit on the amount of drugs you can obtain after you have spent $2,000 out of pocket.