Medicare Part D & Prescription Drug Plans
Serving clients in California, Oregon, Nevada and Arizona, subject to licensing and plan availability.
Helping You Understand and Enroll in Part D Coverage
At Gaddis and Mast Insurance Services, we help Medicare-eligible clients review represented Medicare Part D prescription drug plans in California, Oregon, Nevada and Arizona, subject to licensing and plan availability. These plans are an important part of protecting your health and managing the cost of medications.
If you're new to Medicare or reviewing your current coverage, we’ll help you find a prescription drug plan that matches your needs, works with your medications, and fits your budget.
What Is Medicare Part D?
Medicare Part D is optional prescription drug coverage offered through private insurance companies approved by Medicare. These plans help cover:
- Generic and brand-name medications
- Maintenance prescriptions for chronic conditions
- Medications needed during recovery or short-term illness
Each plan has its own list of covered drugs (called a formulary), pharmacy networks, and cost-sharing details. We'll walk you through these differences to help you make an informed choice.
Medicare Part D – Prescription Drug Coverage
At Gaddis & Mast Insurance Services, we help Medicare-eligible clients review represented Part D prescription drug plans. Availability, formularies, pharmacy networks, premiums, and cost sharing vary by plan and location.
A useful comparison starts with your prescriptions, dosages, preferred pharmacies, ZIP code, and other coverage. Confirm every medication and pharmacy before enrolling.
How We Help
When reviewing represented options, we can help you:
- Compare your current medications against plan formularies
- Review deductibles, copayments, coinsurance, and coverage rules
- Check preferred pharmacies and estimated annual costs
- Review changes again during the appropriate enrollment period
No plan can be confirmed without checking your current prescriptions, pharmacy preferences, location, eligibility, and available options.
Costs & Copays
Premium: varies by plan and may be higher based on income. Annual deductible: varies by plan and cannot exceed $615 in 2026; some plans have no deductible. Copayments or coinsurance: vary by drug, tier, pharmacy, and coverage stage.
Amounts shown are for 2026 and can change annually. Verify current Part D costs.
2026 coverage stages and $2,100 out-of-pocket threshold
- Deductible stage: if the plan has a deductible, you pay covered drug costs until the deductible is met. The 2026 deductible cannot exceed $615.
- Initial coverage stage: after the deductible, you pay the plan’s copayment or coinsurance until qualifying out-of-pocket spending reaches $2,100 in 2026.
- Catastrophic stage: after reaching the threshold, you pay $0 for covered Part D drugs for the rest of the calendar year.
Key facts about the 2026 threshold
- The $2,100 threshold applies to qualifying out-of-pocket spending for covered Part D drugs in 2026.
- Premiums and drugs the plan does not cover do not count toward the threshold.
- The threshold is adjusted annually.
- Review current Part D costs on Medicare.gov.
Medicare Prescription Payment Plan (CoPay Smoothing)
The Medicare Prescription Payment Plan lets participants spread covered out-of-pocket drug costs across the calendar year instead of paying the full amount at the pharmacy. It changes payment timing, not the total amount owed.
Summary Table
2026 summary: deductible of up to $615 if the plan has one; plan copayments or coinsurance during initial coverage; and $0 for covered Part D drugs after qualifying out-of-pocket spending reaches $2,100.
Tips & Considerations
- The $2,100 threshold applies automatically to Part D plans in 2026.
- Premiums do not count toward the threshold.
- Many beneficiaries may not reach the threshold, depending on their covered medication costs.
- Use Medicare Plan Finder to compare plans during Medicare Open Enrollment, October 15 through December 7.
Frequently Asked Questions
When can I change a Part D plan?
The Medicare Annual Enrollment Period runs October 15 through December 7. Other enrollment periods may apply in specific circumstances.
Is the lowest-premium plan always best?
No. Your prescriptions, formulary tiers, deductible, pharmacy, and total expected annual cost all matter.
What is a Part D formulary?
A formulary is the plan’s list of covered drugs. Formularies, tiers, pharmacy networks, and cost sharing can differ by plan and can change.
Can a drug plan require approval before covering a prescription?
Yes. Plans may use rules such as prior authorization, step therapy, or quantity limits for certain drugs.
Do I have to enroll in a Part D plan if I don't take any medications?
You are not required to enroll in Part D if you have other creditable prescription drug coverage. However, if you go 63 days or more without Part D or other creditable prescription drug coverage after you are eligible, you may owe a late-enrollment penalty if you enroll later. The penalty can increase based on the number of uncovered months and may continue for as long as you have Part D coverage.
Questions about your options?
Availability and eligibility depend on your location and circumstances. Contact us to confirm represented options before making a coverage decision.
Contact Gaddis & Mast