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Medicare RX plans

Medicare Part D Prescription Plans

January 1, 2025 · Sure Health Choice

Medicare does not provide coverage for medications. There are two ways to receive prescription coverage, enroll in a Part D plan or receive coverage through a Medicare Advantage Plan.

The average monthly premium for a Part D plan is $35.50 in 2026 . High-income Medicare beneficiaries can expect to pay an income-related monthly-adjusted amount, in addition to the premium. Most pay the standard amount. If you do not enroll when you are first eligible, you may be subject to a penalty. The Extra Help financial assistance program is available for qualified individuals.

Most plans will have a yearly deductible and a maximum out-of-pocket cost. After that amount is met, Medicare will pay up to 75 percent of prescription costs. There are plans available that offer first-dollar coverage with no deductible and the coverage starts immediately.

Most plans will have copayments or coinsurance. Medicare ensures that copayments are no more than 25 percent of the full cost of a prescription, and plans are required to pay no less than 75 percent.

Live in a long-term care nursing facility and are enrolled in both Medicare and Medicaid.

Plan waives the copayment for certain medications.

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