Prescription Savings Made simple

Christine's Corner

Medicare Part D helps cover the cost of prescription medications. These plans are offered by private insurance companies and are available either as a standalone prescription drug plan (PDP) that works alongside Original Medicare or as part of a Medicare Advantage plan (MAPD), which combines medical and prescription drug coverage in one plan.

Key Things to Remember

• Check the formulary (drug list): Your prescription must be included on your plan's drug list (formulary) to be covered.
• If your drug is not listed, your doctor can request a formulary exception.

New in Recent Years

• There is now a yearly out-of-pocket cap for covered prescription drugs.
• In 2026, the limit is $2,100. After that, you pay $0 for covered prescriptions for the remainder of the year.

If You Cannot Afford Your Medications

You have options:

• Step therapy: Try a lower-cost drug first. If it does not work, ask your doctor whether you qualify for an exception.
• Ask about Extra Help, a program that lowers drug costs.
• Talk to your doctor about generic or lower-cost alternatives.

Enrollment Reminders

• Open Enrollment: October 15 – December 7
• You may qualify for a Special Enrollment Period in certain situations.
• If you delay enrolling in Part D, you must show creditable coverage, meaning drug coverage from another source (such as an employer or union plan) that is at least as good as Medicare’s. Without it, you may pay a late enrollment penalty that is added to your monthly premium.

If you have questions or need assistance, please contact SIH Second Act Medicare Counselor, Christine Thompson at christine.thompson@sih.net or call 618.457.5200 ext. 67856.