Understanding Medicare Part D: An Overview With Pennsylvania Examples

Medicare Part D is the portion of Medicare that covers prescription drugs—a crucial benefit for anyone managing chronic conditions or simply trying to stay healthy in retirement. But choosing the right Part D plan isn’t always straightforward.

In this article, we’ll explain what Part D is, who needs it, how to compare options effectively, and what current plans look like using real examples from Berwyn, PA (ZIP 19312) in the Greater Philadelphia region.

What Is Medicare Part D?

Medicare Part D is optional drug coverage available to anyone enrolled in Medicare. It helps pay for prescription medications, including generic and brand-name drugs, at your local pharmacy or via mail order.

Who Can Enroll?

You can enroll in Medicare Part D once you've obtained age 65 and are eligible for Medicare.

You can get Part D coverage in one of two ways:

1. Standalone Prescription Drug Plans (PDPs): For people with Original Medicare (and often Medigap plans)

2. Medicare Advantage Plans (Part C) with Drug Coverage: Combines medical and drug coverage in one plan

   
   

This article focuses on standalone Part D plans, which are commonly used by people with Original Medicare + Medigap (like Plan G or Plan N).

What Does Part D Cover?

Coverage varies by plan, but all Part D plans must cover:

• At least two drugs in each therapeutic category

• Most vaccines

• A wide range of generic and brand-name drugs

Plans organize drugs into tiers, which affect your copay:

• Tier 1: Preferred generics (lowest cost)

• Tier 2: Generic drugs

• Tier 3: Preferred brand-name drugs

• Tier 4+: Higher-cost or specialty drugs

2025 Update: $2,000 Out-of-Pocket Cap

Starting in 2025, all Part D plans include a maximum annual out-of-pocket limit of $2,000 for covered prescription drugs.

This is a huge win for Medicare beneficiaries, especially those with costly medications. Once you hit this limit, you pay nothing for the rest of the year for covered prescription drugs.

How to Research and Compare Medicare Part D Plans

Choosing the right plan involves more than comparing premiums.

Here’s a step-by-step approach:

1. List Your Medications

Make a list of:

• Each prescription drug

• Dosage and frequency

• Your preferred pharmacy

2. Use the Medicare Plan Finder

Go to Medicare.gov/plan-compare. Enter your ZIP code and drug list to get:

• Estimated total yearly costs

• Drug-by-drug breakdowns

• Pharmacy-specific pricing

• Comparisons of premiums, deductibles, copays, and networks

3. Review the Plan Details

Pay attention to:

• Drug coverage tiers

• Preferred pharmacy networks (some plans charge more at non-preferred pharmacies)

• Deductibles (some waive them for certain drugs)

4. Reevaluate Annually

Plans change every year—your drugs, costs, or pharmacy network might too. Use the Plan Finder during the Annual Enrollment Period (Oct 15 – Dec 7).

Real Examples from ZIP Code 19312 (Berwyn, PA)

As of August 2025, there are 14 standalone Part D plans available in the Berwyn, PA area.

Premiums range from $0 to $120+/month, and there are major differences in deductibles, drug tiers, and pharmacy pricing.

Here are some of the most popular and widely available plans*:

Plan Name	Est. Monthly Premium*	Deductible
WellCare Value Script	$0	$590
Cigna Extra Rx	$13	$590
Humana Value Rx	$40	$573
Aetna SilverScript Choice	$45	$590
AARP MedicareRx Saver (UHC)	$64	$590
AARP MedicareRx Preferred (UHC)	$104	$0
Humana Premier Rx	$129	$0

*Premiums and costs can vary slightly depending on exact ZIP code and plan version.

These plans are also offered in many other states, making them good reference points even if you’re not in Pennsylvania.

Common Mistakes to Avoid

• Choosing based on premium alone: A $0/month plan might cost more overall if your medications aren't covered well.

• Not checking your pharmacy network: Using a non-preferred pharmacy can increase costs.

• Forgetting to review annually: Formularies, premiums, and drug pricing can change every year—even within the same plan name.

Summary

If you’re on Medicare and need prescription coverage, a Part D plan is likely essential.

But the “right” plan depends on your:

• Medications

• Preferred pharmacy

• Budget

• Location

The new $2,000 out-of-pocket cost cap for covered prescription drugs in 2025 certainly helps, but cost can still vary depending on your Part D plan choice.

Using tools like the Medicare Plan Finder, doing a yearly review, and comparing coverage based on your actual medications is the smartest way to choose a plan that works for you.

Want To Discuss This Individually?

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This is article is for informational purposes only and should not be considered as tax or legal advice. Advice is only provided after entering into an Advisory Agreement with the Advisor. See other disclosure here: Disclosures