Medicare prescription drug coverage

Medicare prescription drug coverage (Part D) is offered through private insurance companies, like Allina Health | Aetna Medicare. You can get Part D coverage through either:

• A stand-alone prescription drug plan (commonly referred to as a PDP).
• A Medicare Advantage prescription drug plan (commonly referred to as a MAPD).

A prescription drug plan (PDP) is a stand-alone Medicare Part D plan. PDPs only offer Part D and work together with your Original Medicare. This is a good option for someone who wants to stay in Original Medicare but add prescription drug coverage.

A Medicare Advantage prescription drug plan (or MAPD) is a plan that includes medical and prescription drug coverage. MAPD plans are only available through private insurers like Allina Health | Aetna Medicare.

An MAPD plan includes:

• Medicare Part A (hospital)
• Medicare Part B (medical)
• Medicare Part D (prescription)

Like other health plans, MAPDs come in various forms, including PPOs (preferred provider organizations).

• Each plan has a formulary (drug list) showing which drugs it will cover, which tier a drug is on, limits or requirements and mail-order availability. Both generic and brand drugs are covered under Part D. Visit our formulary FAQ page to learn more.
• A generic drug is a prescription drug that is approved by the Food and Drug Administration (FDA) as having the same active ingredient(s) as the brand-name drug. Generally, a “generic” drug works the same as a brand-name drug and usually costs less.
• A brand-name drug is a prescription drug that is made and sold by the company that originally researched and developed the drug. A brand-name drug has the same active ingredients and formula as its generic version.

Here are some examples of what Part D prescription drug plans do not cover:

• Drugs given in hospitals or doctors’ offices that are already covered under Part A or Part B
• Any drugs not listed on a plan’s drug formulary (except in special circumstances)
• Nonprescription drugs or prescription vitamins (other than prenatal vitamins). Other examples include weight loss or weight gain, hair growth and/or erectile dysfunction drugs.

For a more complete list of drugs not covered by Medicare, please visit our Prescription drug formulary FAQ page.

For 2025 plans, there are three phases of Medicare Part D coverage you may enter in a plan year. For 2024 plans, there are four phases of Medicare Part D coverage you may enter in a plan year.
 

What you pay for covered prescriptions may change as you move through the phases. Coverage phases do not affect monthly premium amounts.
 

For 2025 plans, here are the three phases of Medicare Part D coverage:
 

1. The annual deductible phase — You begin in this phase (if your plan has a deductible). You pay the full cost of your covered Part D prescriptions until you meet your plan’s deductible amount (up to $590 in 2025). Only costs for covered drugs go towards your deductible. The process of meeting the deductible starts over again at the beginning of each year.
   
   Keep in mind, some deductibles may only apply to drugs on specific tiers.
2.  The initial coverage phase — This is the phase after you have met your deductible (if it applies). Here, you’ll pay part of the cost (a copay or coinsurance) for your covered Part D prescription drugs. This phase ends when your total out-of-pocket costs for the year reach $2,000 (in 2025).
3. The catastrophic coverage phase — You move from initial coverage to this phase once your out-of-pocket costs for covered Part D prescription drugs reach $2,000 (in 2025). In this phase, you pay a $0 copay/coinsurance for your covered prescription drugs through the end of the plan year.

1. The annual deductible phase — You begin in this phase (if your plan has a deductible). You pay the full cost of your covered prescriptions until you meet your plan’s deductible amount (up to $545 in 2024). The process of meeting the deductible starts over again at the beginning of each year.
   
   Keep in mind, some deductibles may only apply to drugs on specific tiers. 
   
2. The initial coverage phase — This is the phase after you have met your deductible (if it applies) and before your total drug costs have reached the initial coverage limit amount (up to $5,030 in 2024). In this phase, you pay a copayment or coinsurance for each covered prescription you fill until your total drug costs reach the initial coverage limit.
3. The coverage gap phase (donut hole) — This begins after your total drug costs for covered prescription drugs reaches the initial coverage limit amount (up to $5,030 in 2024). In this phase, you’ll pay no more than 25% of the cost for covered brand or generic prescription drugs. This phase ends when you have spent enough to qualify for catastrophic coverage ($8,000 in 2024). 
   
   Some people will never enter the coverage gap because their drug costs won’t be high enough. 
4. The catastrophic coverage phase — You move from the coverage gap to this phase if your out-of-pocket drug spending for the year reaches $8,000 in 2024.  In this phase, the plan pays the full cost of your covered Part D prescription drugs and you'll pay a $0 copay for the rest of the year. 

Yes. Part D, in general, covers recommended adult vaccines when needed to prevent illness.

Under the Inflation Reduction Act, most Part D vaccines recommended for adults (ages 19 and older) given to prevent an illness now have a $0 copay. Vaccines eligible for the $0 copay include those recommended by the Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP). This includes the shingles vaccine.

Check the formulary (drug list) for a list of covered vaccines. And talk to your provider about which ones are right for you.