We offer options multiple Medicare options for your personal health and lifestyle.
Available Plan types
Medicare Advantage Plans (MAPD - HMO & PPO)
Medicare Supplement (Medigap)
Stand Alone Prescription Drug Plans (PDPs)
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What is a Prescription Drug Plan (PDP)?
A Stand-Alone Prescription Drug Plan (PDP) adds prescription drug coverage (Medicare Part D) to Original Medicare (Part A and/or Part B). These plans are offered by Medicare-approved private insurance companies that contract with the federal government to help beneficiaries lower their out-of-pocket prescription medication costs.
For someone to be eligible to receive a Medicare Part D PDP, they must:
* Currently have Medicare Part A, Part B, or both.
* Reside in the specific service area (state or region) where the PDP is being offered.
Unlike Medicare Advantage (Part C) plans, which combine your medical and drug benefits into one single package, a Stand-Alone PDP is designed exclusively to pair with Original Medicare or a Medicare Supplement (Medigap) policy.
Which Prescription Drug Plans are available to you?
Because PDPs are administered by private insurance companies, the monthly premiums, deductibles, and covered medications can vary drastically from one plan to another.
Medicare drug plans are available based on your state of residence. A plan that is highly competitive for a resident in California may have entirely different costs or rules than a plan available in Texas. This is why a licensed agent will always verify your home state and zip code before matching you with a plan.
The Importance of the Plan Formulary
The frank answer to whether your specific medicine is covered is: it depends entirely on the plan’s formulary. A formulary is a structured, tiered list of prescription medications that an insurance carrier agrees to cover.
Each carrier updates their formulary annually. It is critically important to verify that your exact prescriptions—along with your preferred local pharmacy—are optimized within the plan's framework. Choosing a plan without reviewing your specific medications can result in paying full retail price out-of-pocket.
What are the Medicare Part D Coverage Phases?
Unlike other insurance types, standard Medicare prescription drug plans have four distinct coverage phases that change what you pay throughout a calendar year:
1. The Annual Deductible: You pay 100% of your drug costs until you meet the plan's deductible limit. Many plans wave the deductible for generic medications.
2. Initial Coverage Phase: You pay a small copayment or coinsurance for your medications, and the insurance plan pays the rest, until your total combined drug costs hit the initial coverage threshold.
3. The Coverage Gap ("Donut Hole"): Once the initial coverage threshold is breached, you temporarily pay up to 25% of the plan's cost for covered brand-name and generic drugs.
4. Catastrophic Coverage: If your out-of-pocket spending reaches the statutory limit, you automatically transition into catastrophic coverage, meaning you pay $0 out-of-pocket for all covered formulary drugs for the remainder of the calendar year.
Choosing the Right Prescription Drug Plan for you
Each person’s medication profile, budget, and pharmacy preferences are unique. Plan formularies, premium rates, and drug tiers adjust year to year, which is why speaking with a Licensed Agent (Broker) who offers multiple plans is a great way to narrow down your choices.
* Unbiased Analysis: You can review multiple formularies simultaneously from an unbiased source who has experience running drug cost calculators.
* Integrity of Choice: Licensed Agents get the same compensation no matter which drug plan you choose to go with, maintaining the absolute integrity of your evaluation.
* Proactive Oversight: A valuable licensed agent remains current on structural plan revisions—such as changes to preferred pharmacy networks or medication tier drops—that could impact your monthly healthcare expenses.
When can I join or change a Medicare PDP?
You can enroll in or switch a Stand-Alone PDP during the Annual Enrollment Period (AEP), which occurs every year from October 15 to December 7. The changes you make during this window take effect on January 1 of the following year.
Additionally, Special Election Periods (SEPs) may allow you to change your drug coverage mid-year due to unique lifestyle changes, such as moving out of your plan’s service area or losing creditable coverage from a former employer.
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