PDP Pros & Cons

The Case for Medicare Part D Plans

Standalone Part D plans work with Original Medicare to provide prescription drug coverage. They're not perfect, but they offer important advantages.

Pros of Part D Plans

1. Work With Any Medicare Coverage

Part D plans complement Original Medicare and Medigap perfectly. You keep your doctor choice and coverage flexibility.

Unlike Medicare Advantage drug coverage, Part D doesn't restrict your healthcare providers.

2. Nationwide Coverage

Part D plans work anywhere in the United States. Perfect if you travel or spend time in different states.

No worries about network restrictions when you're away from home.

3. $2,000 Annual Cap in 2025

The new out-of-pocket maximum provides real protection against catastrophic drug costs.

Once you spend $2,000 on covered medications, you pay nothing more for the rest of the year.

4. Wide Range of Options

Most areas have 20+ Part D plans to choose from. You can find a plan that covers your specific medications at reasonable costs.

5. Flexibility to Change Plans

Switch Part D plans every year during Open Enrollment without penalty. Easy to adapt as your medication needs change.

Cons of Part D Plans

1. Additional Monthly Premium

Part D plans add another bill to your Medicare costs. Typical premiums range from $30-$60 per month.

Medicare Advantage plans often include drug coverage at no additional premium.

2. Coverage Gap Complexity

Even with the $2,000 cap, understanding how Part D coverage phases work can be confusing.

Deductibles, initial coverage periods, and catastrophic coverage create complex cost calculations.

3. Formulary Restrictions

Not all Part D plans cover every medication. Some drugs require prior authorization or step therapy.

Your preferred medication might not be covered or could be expensive on certain plans.

4. Late Enrollment Penalties

Skip Part D and face lifelong penalties if you enroll later without creditable coverage.

The penalty is 1% of the national base premium for each month you go without coverage.

5. Annual Plan Changes

Your Part D plan can change its formulary, costs, and pharmacy networks each year.

What works great this year might be expensive or inadequate next year.

Who Benefits Most from Part D Plans?

Original Medicare Users

If you have Original Medicare with or without Medigap, Part D is usually your best drug coverage option.

Frequent Travelers

Part D coverage works nationwide, unlike Medicare Advantage plans with limited service areas.

People Who Want Provider Choice

Part D doesn't restrict which doctors or hospitals you can use for medical care.

Those With Expensive Medications

The $2,000 out-of-pocket cap provides valuable protection for people with high drug costs.

Who Might Consider Alternatives?

Budget-Conscious Consumers

Medicare Advantage plans often include drug coverage at lower total monthly costs.

People Who Take Few Medications

If you only take one or two generic drugs, Medicare Advantage might be more cost-effective.

Those Who Want Simplicity

Medicare Advantage combines medical and drug coverage in one plan with one card and one customer service number.

Cost Comparison Example

Let's compare costs for someone taking two common medications:

Scenario: 68-year-old with diabetes and high blood pressure

Medications: Metformin (generic) and Lisinopril (generic)

Tips for Choosing Part D Plans

1. Use Medicare's Plan Finder

Enter your specific medications to compare actual costs across available plans.

Don't just look at premiums—total annual cost is what matters.

2. Check Your Pharmacy

Make sure your preferred pharmacy is in the plan's network. Out-of-network pharmacies cost significantly more.

3. Consider Mail Order

Many plans offer lower costs for 90-day supplies through mail-order pharmacies.

4. Read the Fine Print

Check for prior authorization requirements, quantity limits, and step therapy rules on your medications.

Common Part D Mistakes

Choosing Based on Premium Alone

The cheapest premium might have the highest drug costs. Always calculate total annual expenses.

Not Reviewing Annually

Plans change their formularies and costs each year. What worked last year might be expensive this year.

Ignoring Generic Alternatives

Generic drugs can save hundreds per year compared to brand names. Ask your doctor about alternatives.

The Bottom Line on Part D

Part D plans offer valuable prescription drug protection, especially with the new $2,000 out-of-pocket cap.

They work best for people who want to keep Original Medicare and maintain maximum flexibility in their healthcare choices.

Key takeaway: Part D plans aren't perfect, but they provide essential protection against high drug costs while preserving your freedom to choose any Medicare provider.

Making Your Decision

Consider Part D if you:

• Want to keep your current doctors
• Travel frequently or live in multiple states
• Take expensive medications
• Prefer predictable medical coverage with Original Medicare + Medigap

Consider Medicare Advantage if you:

• Want to minimize monthly premiums
• Take few or no medications
• Don't mind network restrictions
• Want all-in-one coverage simplicity

Remember, you can change your mind each year during Open Enrollment. Start with what makes sense for your current situation and adjust as needed.