- Your annual out-of-pocket Part D costs will be capped at $2,000. This amount includes what you pay for covered drugs during the deductible phase and in copays/coinsurance. After you meet the out-of-pocket limit, you pay $0 for covered drugs for the rest of the year.
- All Part D plans must offer the Medicare Prescription Payment Plan. This payment plan allows you to spread your out-of-pocket drug costs throughout the year. This plan can help even out costs across the year for people who meet the out-of-pocket cap or who have high drug costs during part of the year. People who do not expect to meet the out-of-pocket cap and who have relatively stable drug costs through the year without the program may have higher costs at the end of the year if they opt into the program. To opt in to the payment plan for 2025, contact your plan. You can opt in at any time, and there is no cost to participate in the program. Participating in the payment plan program does not change the total amount that you pay for prescription drugs. It does not decrease or increase your out-of-pocket costs– it only changes when you have to pay.
Your Part D costs (including premiums, deductibles, and coinsurances or copayments) can change every year. Each fall, your plan should send you an Annual Notice of Change (ANOC) to inform you of any changes for the coming year. Your plan cannot change your deductible or premium during the plan year, but the amount you pay for your drugs can change during the year based on which coverage period you are in. The chart below provides general Medicare drug costs for 2024.
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| Medicare Part D costs | ||||
| In 2024, you will pay: | ||||
| Monthly premium | Varies by plan. National base premium is $34.70. People with high incomes have a higher Part D premium. | |||
| Annual deductible | Varies by plan. Cannot be more than $545 if you do not have Extra Help. For those with Extra Help: $0 | |||
| Coinsurance/copays if you do not have Extra Help | Vary by plan and by drug within plan. In most plans, after spending usually $5,030 in total drug costs, you reach the coverage gap. During the coverage gap you will have to pay 25% of the cost of your drugs.
In all plans, after spending $8,000 out of pocket, you will leave the coverage gap and reach catastrophic coverage. During this period, you will owe no cost-sharing for the cost of your covered drugs. |
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| Coinsurance/copays if you have Medicaid and/or Extra Help | If you have Medicaid and your income is below 100% of the federal poverty level (FPL) ($14,580/year in 2024 for individuals and $19,720/year for couples), you will pay $1.55 for generics and $4.60 for brand-name drugs. After spending $11,477.39 in total drug costs, you will reach catastrophic coverage and pay $0 for each drug for the rest of the calendar year.
If you have Extra Help, you will pay $4.50 for generics and $11.20 for brand-name drugs. After spending $11,477.39 in total drug costs, you will reach catastrophic coverage and pay $0 for each drug for the rest of the calendar year. |
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Note: Many drug plans have preferred and non-preferred pharmacies in their network. You may pay less for your drugs at preferred pharmacies.