How Does a Medicare Part D Plan Work?

tobyselby
Sep 30
2 min read

Medicare Part D is the program that helps cover prescription drugs for Medicare beneficiaries. Many are confused that because it is called "Medicare Part D" that it is administered by Medicare. Part D plans are actually offered through private insurers approved by Medicare, and beneficiaries enroll in a Part D plan (standalone or as part of a Medicare Advantage + drug plan).

The Medicare Initial Enrollment Period (IEP) last seven months. This includes three months before your birth month, your birth month, and three months after your birth month. You can then change plans annually during the annual enrollment period for Medicare Part D drug plans which is from October 15-December 7th.

Selby Insurance works with multiple insurance companies in Arkansas that offer Medicare Part D plans including Aetna, Arkansas Blue Cross Blue Shield, Centene, Cigna, Fidelis, Humana, United Healthcare, and Wellcare. We service areas all over Northeast Arkansas.

Key elements of a typical Part D plan include:

A monthly premium you pay to the insurance company providing your plan coverage. These payments can be placed on a monthly bank draft, coupon payments, or paid directly from your Social Security check.
A deductible (for those plans that use one) — you pay full cost of covered drugs until the deductible is met. For 2026, most deductibles for Part D Drug plans will be $615 annually.
Cost-sharing (copays or coinsurance) once you have the plan's deductible requirement.
A coverage gap / “donut hole” (in prior years) — was a phase where beneficiaries had to pay more of the drug cost — though that structure has been phased out under newer reforms.
Catastrophic coverage — once your out-of-pocket costs reach a threshold, your cost-sharing is greatly reduced (sometimes to zero). The Medicare Part D out-of-pocket threshold for 2026 is $2,100. Once you reach this limit for your covered Part D drugs, you will not have to pay any further copayments or coinsurance for the rest of the year. In earlier years, beneficiaries with very high drug costs could face extremely large expenses. The Inflation Reduction Act (IRA) passed in 2022 began to change that, and the changes are rolling out over multiple years.

Selby Insurance offers plans from multiple carriers across Arkansas including cities such as Jonesboro, Paragould, Brookland, Bono, Blytheville, Harrisburg, Trumann, Lake City, Monette, Newport, Hoxie, Walnut Ridge, Leachville, Marked Tree, Manila, Tyronza, and West Memphis. Selby Insurance is located at 2216 Wilkins Avenue, Jonesboro, AR 72401. Selby Insurance can be reached for Medicare Part D assistance at (870) 336-2121. You may also find us on our website at https://www.selbyinsurance.com/medicare-insurance.