Choosing the Right Plan Starts With Your Medications
When signing up for Medicare, choosing the right Part D prescription drug plan depends entirely on what medications you take. Each drug is placed into a tier — generics are usually Tier 1 or Tier 2, while brand-name and specialty drugs fall into higher tiers. If all your prescriptions are generics, there’s usually no need to pay for a high-cost plan. In these cases, we can help you choose a low-cost option that still gives you the coverage you need.
Expensive Medications May Require a More Comprehensive Plan
If you take expensive or specialty medications, there are benefits to enrolling in a higher-premium Part D plan. Some drugs — especially those that are brand-name or more specialized — are only covered by certain plans. For those with minimal drug needs or only taking generics, one of the many plans under $10/month is often the best fit. It’s also important to note that all Part D plans, regardless of monthly premium, share the same annual out-of-pocket maximum of $2,000 for prescriptions in 2025.
What Does “Out-of-Pocket Maximum” Mean?
The out-of-pocket maximum is the most you’ll pay for your prescriptions in a calendar year under your Part D plan. In 2025, that limit is $2,000. Once you’ve spent that amount — through copays, coinsurance, and deductibles — your plan covers the rest of your covered prescriptions at no cost for the rest of the year. This new cap is a huge improvement for those taking expensive medications, since it protects you from runaway drug costs. It’s important to know that only costs paid through your Part D plan count toward this $2,000 max — anything paid out-of-pocket with a coupon like GoodRx doesn’t contribute to that total.
When to Use GoodRx Instead of Your Insurance
Not every prescription needs to go through your insurance. In fact, sometimes using a coupon like GoodRx can save you more money than your Part D plan — especially if the drug cost doesn’t help you meet your deductible or out-of-pocket max. This is often the case for one-time prescriptions, like pain meds after surgery or short-term antibiotics. On the other hand, if you regularly take medications and expect to hit your $2,000 maximum, it’s best to keep running everything through your Part D plan.
Should You Switch Part D Plans?
Possibly! But that depends on your current medications and whether they are still being covered in the most affordable way. That’s where we come in. At HealthyMarks, we evaluate your current prescriptions and Part D coverage to make sure you’re getting the most value. Give us a call — we’ll help you make the right switch if needed.
Keaton Marks is the owner and CEO at HealthyMarks including the medicare team. Keaton was born and raised in Encinitas. He often rode his bike through town and to the local beaches like Moonlight. Keaton knows it is important to have a local resource, someone who understands the area, the hospitals and networks of doctors. Keaton is proud to be a local Medicare broker who is able to assist the people in his town when selecting medicare plans.
Keaton believes one thing above all else: “Medicare is confusing… but it doesn’t have to be! That is where HealthyMarks Medicare comes in” Please contact me with any questions.