Medicare Part D 101: What You Need to Know Before You Enroll

Silver Crest Insurance
5 minutes ago
3 min read

Prescription drug costs can add up quickly — especially as we age or manage chronic conditions. That’s where Medicare Part D, the federal government’s prescription drug coverage program, comes in.

If you’re new to Medicare or reviewing your current plan, understanding how Part D works can help you avoid unexpected costs and ensure your medications remain affordable.

What Is Medicare Part D?

Medicare Part D is a prescription drug coverage program offered through private insurance companies approved by Medicare. It helps pay for both brand-name and generic medications, and it’s available to anyone enrolled in Medicare Part A or Part B.

You can get Part D coverage in two ways:

By adding a stand-alone Part D plan to your Original Medicare (Parts A & B).
By enrolling in a Medicare Advantage plan (Part C) that includes prescription drug coverage.

Each plan has its own list of covered medications (called a formulary), premium, deductible, and pharmacy network, so comparing options is crucial.

Why You Should Have Part D Coverage

Even if you don’t take many prescriptions now, it’s still smart to enroll in a Part D plan when you’re first eligible. Why?

You’ll be protected from sudden high drug costs if your health changes later.
You’ll avoid the Late Enrollment Penalty, which permanently increases your monthly premium if you delay coverage.
You’ll have access to negotiated prices that are often lower than retail rates.

At Silver Crest Insurance, we’ve seen many clients save hundreds of dollars each year simply by choosing the plan that best fits their current prescriptions.

Understanding the Costs

A Medicare Part D plan may include:

Monthly Premium: What you pay for the plan itself (varies by provider).
Annual Deductible: What you pay out-of-pocket before your plan begins to share costs.
Copayments or Coinsurance: Your share of the cost each time you fill a prescription.
Coverage Gap (“Donut Hole”): A temporary limit on what the plan covers after you and your plan have spent a certain amount on drugs.
Catastrophic Coverage: After you’ve spent enough out of pocket, you’ll pay only a small coinsurance or copayment for the rest of the year.

Plan costs can vary widely, even for the same medications. Reviewing options each year during the Medicare Annual Enrollment Period (October 15 – December 7) ensures you’re still getting the best value.

What to Look For When Choosing a Plan

When comparing plans, pay attention to:

Formulary: Does the plan cover your prescriptions? Are they in preferred tiers?
Pharmacy Network: Can you continue using your preferred pharmacy (local or mail-order)?
Annual Cost Projection: Add up the premium, deductible, and estimated drug copays.
Star Ratings: Medicare rates plans 1 – 5 stars for performance and service quality.

At Silver Crest Insurance, we simplify this process by reviewing your current medications and helping you compare multiple plan options side-by-side.

When to Enroll in Medicare Part D

You can enroll:

During your Initial Enrollment Period (three months before and after your 65th birthday month).
During the Annual Enrollment Period each fall (October 15 – December 7).
If you qualify for a Special Enrollment Period (for example, losing employer drug coverage or moving out of your plan’s service area).

Failing to enroll when first eligible — without other credible prescription coverage — means you’ll likely pay a lifetime penalty added to your monthly premium.

Why Work with a Local Independent Agent Like Silver Crest Insurance

Choosing the right Medicare Part D plan can be confusing, especially when formularies and premiums change every year.

Our licensed agents at Silver Crest Insurance:

Compare all available plans in your county or ZIP code.
Help confirm your prescriptions and preferred pharmacies are covered.
Guide you through enrollment — at no cost to you.

We proudly serve clients across Eastern Pennsylvania and Central New Jersey, providing personalized Medicare support year after year.