Medicare Part D & Prescription Drug Plans

Helping You Understand and Enroll in Part D Coverage

At  Gaddis and Mast Insurance Services, we help Medicare-eligible individuals throughout California — including Santa Rosa and Nevada — explore and enroll in Medicare Part D prescription drug plans. 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.

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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

Medicare Part D is an optional prescription drug coverage program available to anyone with Medicare. You can enroll in a standalone Part D plan (if you have Original Medicare) or as part of a Medicare Advantage plan that includes drug coverage (MAPD).

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How We Help

When you work with us, you’ll receive: 


  • A review of your current medications to find the most cost-effective coverage
  • Guidance on how deductibles, copays, and the coverage gap ("donut hole") may affect your costs
  • Yearly plan reviews to make sure your coverage still fits your needs
  • No-cost, one-on-one support — we’re here to help, not sell


Choosing the right Part D plan doesn’t have to be confusing. With our help, you’ll feel confident that your medications are covered and your plan fits your lifestyle.

  • A medical bill with a stethoscope and pills on it.

Costs & Copays

Premium – Monthly fee varies by plan and based on factors like income. Annual Deductible – For example, may be up to $590 in 2025 (some plans waive it). Copays or Coinsurance – You pay a set amount or percentage per prescription, depending on the drug tier.


Typical copays:

  • Tier 1 (Generic): Low copays (e.g., $0–$10)
  • Tier 2 (Preferred Brand): Moderate copays (e.g., $30–$50)
  • Tier 3 (Nonâ– Preferred Brand): Higher copays (e.g., $75+)
  • Tier 4 (Specialty Drugs): Coinsurance (often 25–33%)

Coverage Phases & $2,000 Cap

  1. Deductible Phase: You pay full cost for drugs until hitting your deductible (up to ~$590 in 2025).
  2. Initial Coverage: After deductible, you pay copays or ~25% coinsurance. This continues until your out of pocket spending on covered drugs—counting deductibles, copays, and coinsurance—hits $2,000 in 2025.
  3. Catastrophic Coverage: Once the $2,000 cap is reached, your Part D plan covers 100% of costs for covered prescription drugs for the rest of the year.

Key Facts About the $2,000 Cap

  • The annual cap of $2,000 applies to out-of-pocket costs for all covered Part D prescription drugs.
  • It does not include premiums or drugs not covered by your plan.
  • This cap goes into effect January 1, 2025, under the Inflation Reduction Act.
  • The cap will be indexed annually (e.g., rising to $2,100 in 2026).

Medicare Prescription Payment Plan (CoPay Smoothing)

Starting in 2025, Part D plans may let you spread your copay/coinsurance costs across the calendar year, instead of paying at the pharmacy. This helps manage cash flow but doesn’t reduce total cost.

Summary Table

Phase | Your Costs until $2,000 Cap ------|------------------------------------- Deductible Phase | Up to ~$590 (if plan has deductible) Initial Coverage | Copays or ~25% coinsurance per drug Catastrophic Coverage | $0 copays for covered drugs after $2,000 reached

Tips & Considerations

  • The $2,000 cap applies automatically to all Part D plans.
  • Premiums do not count toward the cap.
  • Many beneficiaries may not reach the cap depending on medication needs.
  • Use Medicare’s Plan Finder to compare plans during Open Enrollment (Oct. 15–Dec. 7).