What are the 4 phases of Medicare Part D coverage?

Asked by: Mr. Mikel Champlin DDS  |  Last update: January 26, 2026
Score: 4.8/5 (69 votes)

Understanding the stages of your Medicare prescription drug coverage may help you manage your costs over the course of your plan year.
  • Stage 1—deductible stage. ...
  • Stage 2—initial coverage stage. ...
  • Stage 3—Medicare Part D coverage gap. ...
  • Stage 4—catastrophic coverage.

What are the four stages of Medicare Part D?

Four phases of Medicare Part D
  • Deductible phase. This is the first phase. ...
  • Initial coverage phase. If your plan has no deductible, you'll start in the initial coverage phase. ...
  • Coverage gap phase. ...
  • Catastrophic phase.

Is there a way to avoid the donut hole?

Tips on How to Avoid the Donut Hole Coverage Gap

Discuss lower-cost drug alternatives with your healthcare professionals. Seek out discounts on medications. Choose generic drugs over brand-name drugs.

What are the 4 parts of Medicare explained?

Part A provides inpatient/hospital coverage. Part B provides outpatient/medical coverage. Part C offers an alternate way to receive your Medicare benefits (see below for more information). Part D provides prescription drug coverage.

What are the disadvantages of Medicare Part D?

Disadvantages of Medicare Part D Prescription Drug plans include:
  • Need to anticipate your prescription drug needs for the year: Part D plans differ in the types of drugs they cover. ...
  • Plans differ from insurer to insurer: Part D plans must offer a minimum amount of coverage per Medicare, but otherwise plans can differ.

2022 Medicare Part D Drug Coverage Phases

33 related questions found

What is the best Medicare plan that covers everything for seniors?

Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. A person can consider their income and how much they are able to spend before choosing a Medicare plan. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.

Why are people leaving Medicare Advantage Plans?

But there are trade-offs. Medicare Advantage plans often have a limited network of hospitals and physicians. And while the premiums are typically low, enrollees could end up paying more in the long run in copays and deductibles if they develop a serious illness.

What are the 6 things Medicare doesn't cover?

Some of the items and services Medicare doesn't cover include:
  • Eye exams (for prescription eyeglasses)
  • Long-term care.
  • Cosmetic surgery.
  • Massage therapy.
  • Routine physical exams.
  • Hearing aids and exams for fitting them.

What are the top 5 medicare supplement plans?

💬 From our Nerds: What are the top five Medicare supplement plans? "Based on NerdWallet's Medigap rubric, I picked five best Medicare Supplement Insurance companies for 2025: AARP/UnitedHealthcare, Mutual of Omaha, State Farm, Anthem and Blue Cross Blue Shield.

Who pays for drugs in the donut hole?

Just like in the initial coverage period, when you entered the donut hole, you would be responsible for paying 25% of the costs of your medications.

Is the Medicare donut hole going away in 2025?

The Inflation Reduction Act (IRA) signed by President Biden in 2022 will eliminate the Prescription Drugs Coverage Gap (known as the donut hole) for Seniors in 2025. Most Medicare drug plans have a coverage gap (also called the "donut hole").

Does GoodRx count towards the donut hole?

Avoid falling into the Medicare donut hole too soon

You can use your Medicare plan for your more expensive brand drugs, and use GoodRx to purchase your less expensive generic medications. The cost of drugs purchased under GoodRx will not count against your coverage limit - thus keeping you out of the donut hole longer.

What are the phases of Medicare Part D 2025?

The CY 2025 updates include the following: - A newly defined standard Part D benefit design consisting of three phases: annual deductible, initial coverage, and catastrophic coverage; - A lower annual out-of-pocket (OOP) threshold of $2,000; Page 2 2 - The sunset of the Coverage Gap Discount Program (CGDP) and ...

What is Tier 6 in Medicare Part D?

Drugs in the Select Care tier (Tier 6) have a $0 copay for up to a 90-day supply in the Initial Coverage stage. This includes a select number of medications used to treat high blood pressure, diabetes and high cholesterol.

What is the most popular Part D drug plan?

The best Medicare Part D provider is Aetna. It has top ratings from the Centers for Medicare & Medicaid Services and affordable premiums. Other great providers include Wellcare and UnitedHealthcare.

How much money does Medicare allow you to have in the bank?

This means individuals can have any amount of assets and still qualify for a Medicare Savings Program. Assets are things that you own, such as bank accounts, cash, second homes and vehicles.

What are three services not covered by Medicare?

We don't cover these routine items and services: Routine or annual physical checkups (visit Medicare Wellness Visits to learn about exceptions). exams required by third parties, like insurance companies, businesses, or government agencies. Eye exams for prescribing, fitting, or changing eyeglasses.

How often will Medicare pay for a hospital bed?

When a doctor deems it medically necessary, Medicare will cover hospital beds to use at home. Generally, Part B will cover 80% of the cost. Medigap and Medicare Advantage may pay more. There are times when a doctor may feel it is medically necessary for a person to use a hospital bed at home.

Is there a medicare supplement that covers everything?

With Medicare Supplement Plan F, you get the most complete coverage available. And because Plan F also covers costs in excess of Medicare-approved amounts, you may have no out-of-pocket costs for hospital and doctor's office care.

What blood tests does Medicare not cover for seniors?

It's important to know that Medicare won't cover any blood test if it isn't medically necessary. If you seek a blood test on your own, it's unlikely you'll get it covered. Tests not covered may include those for employment purposes, wellness screenings, or routine monitoring without medical necessity.

Why is Humana dropping Medicare?

Rising medical costs and lower reimbursements from CMS led Humana and other insurers to plan market exits in 2025.

Why are seniors losing their Medicare Advantage plans?

Health systems and hospitals are also making the decision to cancel contracts due to excessive prior authorization denial rates and slow payments from insurers. Already 27 health systems have canceled their Medicare Advantage contracts this year.

Is Mayo Clinic no longer accepting Medicare Advantage plans?

We do not accept noncontracted Medicare Advantage Plans.