Start with your current medications and their costs

Before you compare any plans, make a list of every prescription you take regularly — include the drug name, strength, and how often you refill it. Then go to Medicare.gov and use the Plan Finder tool. Enter your medications and your pharmacy, and the tool will show you which plans cover each drug and what you will pay out of pocket at that specific pharmacy.

This step matters more than plan name or monthly premium. A plan with a lower monthly cost might charge much more per dose for your blood pressure medication, or it might not cover your arthritis drug at all. The Plan Finder shows you the total yearly cost — premiums plus copays and coinsurance — so you can compare the real expense, not just the headline number.

If you take many medications or expensive ones, ask your doctor's office to print a current medication list with dosages. Pharmacies sometimes list drugs by brand name only, and the Plan Finder works better when you search by both brand and generic names.

Key Takeaways

  • Use Medicare.gov's Plan Finder tool with your actual medications and pharmacy to see what each plan will cost you in a year, not just the monthly premium.
  • Plans change their drug coverage and costs every year, so you must check again during the annual enrollment period even if you were happy with your plan last year.
  • If your pharmacy is not in a plan's network or a drug is not covered, you can ask your doctor to request a coverage exception, but this takes time and is not always granted.
  • The lowest-premium plan is rarely the cheapest overall; compare total yearly costs including copays, not premium alone.
  • You can switch plans once a year during the annual enrollment period (October 15 to December 7), and changes take effect January 1.

Understand the coverage stages and what you pay at each one

Every Part D plan has the same structure: you pay a monthly premium, then you hit a deductible (usually $545 in 2024, though this changes yearly), then you enter the coverage stage where you pay a copay or coinsurance on each prescription. Once your out-of-pocket costs reach a certain limit (usually around $5,500 in 2024), you enter catastrophic coverage and pay only a small amount per prescription for the rest of the year.

The Plan Finder shows you what happens at each stage for your specific drugs. Some plans have no deductible, which means you start paying copays right away — useful if you take expensive medications from the start of the year. Other plans have a high deductible but lower copays afterward. The right choice depends on whether you need expensive drugs when ready or whether your costs spread across the year.

The coverage gap (sometimes called the "donut hole") is less punishing than it used to be, but it still exists. Once you and your plan have spent a combined $5,500 on covered drugs, you enter the gap and pay a higher percentage of the drug cost until you reach catastrophic coverage. The Plan Finder calculates this for you, so you will see the total cost including the gap.

Check whether your pharmacy is in the plan's network

Each Part D plan contracts with certain pharmacies. If you use a mail-order pharmacy or a specialty pharmacy for expensive drugs, confirm that pharmacy is in the plan's network before you choose. The Plan Finder lets you search by pharmacy name, and you can also call the plan directly to ask.

If your preferred pharmacy is not in a plan's network, you have two options: switch to a pharmacy that is in the network, or ask the plan for a network exception. Exceptions are sometimes granted, but they take time to process and are not may provide. It is easier to choose a plan that already includes your pharmacy.

If you live in a rural area or travel frequently, check how many pharmacies are in the network and where they are located. Some plans have fewer pharmacies in remote areas, which can mean long drives or relying on mail-order delivery.

Compare plans side by side using the Plan Finder results

The Plan Finder shows you a list of plans ranked by estimated yearly cost for your specific situation. Do not stop at the first one. Open the top three to five plans and compare them in detail. Look at the monthly premium, the deductible, the copays for each of your drugs, and the total yearly cost.

Pay attention to whether copays are fixed amounts (like $10 per prescription) or percentages of the drug cost (coinsurance). Fixed copays are easier to budget for. Coinsurance can be cheaper for generic drugs but much more expensive for brand-name drugs, especially in the coverage gap.

Some plans offer extra benefits like mail-order delivery, automatic refills, or coverage for over-the-counter items. These matter only if you will actually use them. A plan that covers over-the-counter pain relievers is not worth choosing if you never buy them.

Know the rules for changing plans and requesting coverage exceptions

You can change Part D plans once a year during the annual enrollment period, which runs from October 15 to December 7. Your new plan takes effect on January 1. If you miss this window, you cannot switch unless you have a may have access to life event — moving to a new state, losing other coverage, or becoming newly may be able to access for Medicare.

If you choose a plan and then discover it does not cover a drug you need, you can ask the plan for a coverage exception. Your doctor must submit the request, usually by phone or fax. The plan has 72 hours to respond for urgent requests or 24 hours for non-urgent ones. Exceptions are sometimes granted, but they are not automatic, and the process can delay your prescription.

If a plan stops covering a drug you take, or if the copay increases significantly, you can request a mid-year plan change. This is rare, but it is possible if the change creates a hardship. Contact Medicare at 1-800-MEDICARE to ask whether you may have access to.

Review your plan every year during open enrollment

Plans change their drug coverage, copays, and premiums every year. A plan that was perfect for you in 2024 might cost much more in 2025, or it might stop covering a drug you depend on. You must check your plan again during the annual enrollment period, even if you were happy with it last year.

Set a reminder for mid-October to log into Medicare.gov and run the Plan Finder again with your current medications. Spend 20 minutes comparing your current plan to the top alternatives. If you find a cheaper option or better coverage, you can switch with no penalty.

If you do not actively choose a plan during open enrollment and you are in a plan that is being discontinued, Medicare will move you to a different plan automatically. This automatic assignment is usually not in your best interest, so it is worth taking the time to choose yourself.

Understand brand-name versus generic drugs and tier placement

Plans place drugs into tiers, and your copay depends on the tier. Tier 1 is usually generic drugs with the lowest copay. Tier 2 is preferred brand-name drugs with a higher copay. Tier 3 and above are non-preferred drugs with even higher copays or coinsurance. Some plans have specialty tiers for very expensive drugs.

If your doctor prescribes a brand-name drug, ask whether a generic version is available and whether it would work for you. Switching to a generic can cut your copay in half or more. If you need the brand-name version, check which tier it is on in each plan you are considering — the same drug might be Tier 2 in one plan and Tier 4 in another.

If your doctor believes the brand-name drug is medically necessary and the generic will not work, you can ask the plan for a prior authorization or a formulary exception. Your doctor makes the request, and the plan decides whether to cover the brand-name drug at the generic copay. This process takes a few days and is not always approved.

Frequently Asked Questions

What if I take a drug that no Part D plan covers?

This is rare, but it happens with some very new drugs or drugs used for rare conditions. If no plan covers your drug, contact Medicare at 1-800-MEDICARE and ask about the Part D coverage gap discount program or other options. Your doctor may also be able to request a coverage exception or suggest an alternative drug that is covered.

Can I change plans if my costs go up during the year?

Not normally. You can only change plans during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event like moving or losing other coverage. If a plan stops covering a drug you take, you may be able to request a mid-year change, but this requires Medicare to determine that the change creates a hardship.

Do I have to use the pharmacy listed in the plan, or can I use any pharmacy?

You should use a pharmacy in the plan's network to get the negotiated copay. If you use an out-of-network pharmacy, you will pay more out of pocket, and the plan may not cover the cost at all. You can ask the plan for a network exception, but it is not may provide.

What happens to my Part D plan if I move to a different state?

Your current plan may not be available in your new state. Moving is a may have access to life event, so you can change plans outside the annual enrollment period. Contact your current plan and Medicare to find out what plans are available where you are moving and when you need to switch.

Is it worth paying a higher premium for a plan with better coverage?

Only if the better coverage saves you money on copays and coinsurance. Use the Plan Finder to calculate your total yearly cost in each plan, including the premium. A plan with a $50 monthly premium might cost less overall than a plan with a $20 premium if your copays are much lower.