Plan guide
Part D drug plans
The right Part D plan depends on your exact prescriptions and pharmacy. We check both, drug by drug, before you enroll.
Overview
Part D plans cover prescription drugs for people on Original Medicare. They are sold by private carriers and every plan has its own formulary, the list of drugs it covers, sorted into cost tiers. A plan that is cheapest for your neighbor may cost you hundreds more if one of your medications sits on a higher tier.
Since 2025, Part D has an annual out-of-pocket cap on covered drugs, and the Medicare Prescription Payment Plan lets you spread those costs across the year instead of paying at the counter. Insulin copays are capped at $35 for a month's supply on covered insulins.
If you go without creditable drug coverage for 63 days or more after your Initial Enrollment Period, a late enrollment penalty is added to your premium for as long as you have Part D. Even if you take no medications today, a low-premium plan protects you from that penalty.
What's included
Formulary drugs by tier
Generics, preferred brands, non-preferred drugs and specialty medications, each with its own copay or coinsurance.
Preferred pharmacy pricing
Lower copays at in-network preferred pharmacies such as many Kroger, Walgreens and CVS locations.
Mail-order options
90-day supplies delivered to your home, often at the lowest cost.
Annual out-of-pocket cap
Once you reach the yearly limit on covered drugs, you pay nothing more that year.
Insulin cost limit
Covered insulin is capped at $35 for a one-month supply.
Recommended vaccines
Shingles and other ACIP-recommended vaccines at no cost.
Part D formulary guide
Use these five steps with any plan's formulary, or bring your list to us and we will run it for you.
Write down every prescription
Include the exact name, strength, form (tablet, injection, inhaler) and how many you fill each month. Brand and generic versions can land on different tiers.
Look up each drug on the formulary
Search the plan's current-year formulary, not last year's. Note the tier and any letters beside it: PA for prior authorization, ST for step therapy, QL for quantity limits.
Price it at your pharmacy
Compare the preferred pharmacy price, the standard pharmacy price and mail order. The difference on a tier 3 brand can be more than $30 a month.
Add up the whole year
Premium times 12, plus the deductible, plus each monthly copay. Remember the annual out-of-pocket cap on covered drugs.
Read the Annual Notice of Change
Every September your plan mails an ANOC. Check it for tier changes and removed drugs before the Annual Enrollment Period opens on October 15.
Typical drug tiers in Indiana plans
| Tier | Type | Examples | Typical cost (sample) |
|---|---|---|---|
| Tier 1 | Preferred generic | Lisinopril, atorvastatin | $0 to $5 |
| Tier 2 | Generic | Metformin ER, sertraline | $5 to $15 |
| Tier 3 | Preferred brand | Eliquis, Jardiance | $40 to $47 or 15% to 25% |
| Tier 4 | Non-preferred drug | Brands with generic options | 40% to 50% |
| Tier 5 | Specialty | Biologics, some cancer drugs | 25% to 33% |
Extra Help, and the four Medicare Savings Programs
Roughly one Medicare household in four qualifies for help with Part D costs, and most of them never apply. Here is what the subsidy pays and where each application goes.
Extra Help is the federal subsidy that pays most of a Part D drug plan for people with limited income and resources. Around one Medicare household in four qualifies, and a large share of them never apply, usually because nobody told them the programme exists.
You are deemed eligible automatically if
- You have full Indiana Medicaid, including Hoosier Care Connect or PathWays for Aging.
- You receive Supplemental Security Income (SSI) from Social Security.
- You are enrolled in a Medicare Savings Program: QMB, SLMB or QI.
What the subsidy actually pays
- The Part D premiumPaid in full up to the Indiana regional benchmark amount. Choose a plan priced above the benchmark and you pay only the difference, not the whole premium.
- The Part D deductibleWaived entirely. You start at the capped copay on day one instead of paying the first $615 of drug costs yourself (sample).
- Copays, capped by lawAbout $4.90 for a generic and $12.15 for a covered brand-name drug, then $0 once your out-of-pocket spending reaches the catastrophic threshold (sample).
- The late enrollment penaltyThe 1%-per-month Part D penalty is removed while you hold Extra Help, and those months do not come back to be charged later.
- An extra chance to change plansGaining, losing or changing Extra Help opens a Special Enrollment Period you can use once in each of the first three quarters of the year.
- Any network pharmacyThe capped copay applies at every pharmacy in the plan's network, and a 90-day or mail-order supply still works the way it normally would.
The four Medicare Savings Programs Sample 2026 limits
- QMBQualified Medicare Beneficiary
Part A and Part B premiums, plus deductibles, coinsurance and copays. A provider may not bill you for the balance.
The broadest of the four. People with QMB pay close to nothing out of pocket for Medicare-covered care.
Income limitUp to about $1,325 a month single, $1,783 a couple (sample)
- SLMBSpecified Low-Income Medicare Beneficiary
The Part B premium only, which puts roughly $203 a month back into a Social Security payment (sample).
For people just above the QMB line. Deductibles and coinsurance stay yours to pay.
Income limitAbout $1,326 to $1,585 a month single (sample)
- QIQualifying Individual
The Part B premium only. It is funded by a fixed block grant, so it is granted first come, first served each year.
You cannot hold QI and full Medicaid at once. Reapply early every January.
Income limitAbout $1,586 to $1,781 a month single (sample)
- QDWIQualified Disabled and Working Individual
The Part A premium, for people under 65 who returned to work and lost premium-free Part A.
Rare and frequently missed. Worth checking for anyone under 65 who went back to work after a disability.
Income limitUp to about $5,300 a month single (sample)
Indiana counts income and resources differently from most states and disregards the first portion of earned income, so apply even if you think you are slightly over. Limits shown are demo figures.
Where each application goes
- Extra HelpApply to Social Security, online at ssa.gov, by phone or at the Indianapolis field office. There is no cost and no agent involved.
- A Savings ProgramApply to Indiana Medicaid through the FSSA Division of Family Resources. Approval deems you for Extra Help automatically.
- Both, in either orderThey are separate applications with different agencies. Most people who qualify for one qualify for the other, so file both.
Costs to plan for
Sample figures- Monthly premium
- $0 to $70
- Maximum deductible
- $615
- Out-of-pocket cap
- $2,100/yr
- Covered insulin
- $35/mo max
Typical Indiana range (sample)
Many plans set it lower or waive it for tier 1 (2026 sample figure)
On covered drugs (2026 sample figure)
Per one-month supply
Figures are illustrations for Central Indiana. Your actual costs depend on the plan, your ZIP code, age and income. Confirm current amounts at Medicare.gov.
How we help with Part D drug plans
- 1
Build your drug list
Name, dosage and how often you fill each prescription, including 90-day supplies.
- 2
Choose your pharmacies
We price your list at the pharmacies you actually use, plus mail order.
- 3
Compare total yearly cost
Premium, deductible and every copay added together, month by month.
- 4
Re-check every October
Formularies and tiers change each year, so we rerun your list each fall.
Is it a fit?
Often a good fit when
- You are on Original Medicare with or without a Supplement
- You want to avoid the late enrollment penalty
- You take brand-name or specialty medications
Watch out for
- Formularies and tiers change every January
- Prior authorization or step therapy may apply
- Not needed if your Advantage plan already includes drugs
Questions about Part D drug plans
We usually still recommend a low-premium plan so you avoid the late enrollment penalty, which is permanent and grows the longer you wait.
If your drug is not on the formulary or has a restriction, your doctor can ask the plan for an exception. Plans must answer within 72 hours, or 24 hours for an expedited request.
Yes. Extra Help, also called the Low-Income Subsidy, reduces premiums and copays for people with limited income and resources. We can check eligibility and help you apply through Social Security.
Generally yes. VA and TRICARE For Life drug coverage are considered creditable, so you can delay Part D without a penalty. Keep the annual creditable coverage notice with your records.
Related coverage
Original MedicarePart A hospital insurance and Part B medical insurance, run by the federal government.Read the guide 
Medicare SupplementMedigap policies that pay some or all of the costs Original Medicare leaves behind.Read the guide 
Medicare AdvantagePart C plans from private carriers that bundle hospital, medical and usually drug coverage.Read the guide
Questions about Part D drug plans?
A licensed Beacon advisor will compare plans against your doctors, prescriptions and budget. No cost, no obligation.
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