The Centers for Medicare & Medicaid Services (CMS)made changes to Medicare Part D prescription drug coverage in 2025 that may continue to impact your coverage and costs.

Now is the time to review your Medicare coverage options to make sure you have the best plan for your needs. And, if you don’t have a Medicare Advantage plan, you may want to consider making the switch.

What you need to know about Medicare Part D There are a lot of factors to keep in mind when looking over Medicare plans, and with the changes to Medicare Part D, a lot of questions can arise that are difficult to sort through.

Here are answers to some of the most commonly asked questions about Medicare Part D. If you need more help, make sure you reach out to a trusted Medicare Advantage Plan agent for more information about your coverage options.

What is Medicare Part D?

Medicare Part D is a federal program that provides prescription drug coverage for Medicare members. It is available through private insurance companies approved by Medicare.

What does Medicare Part D cover?

Medicare Part D coverage has a structured system in place that determines which drugs are covered and at what cost. When it comes to Medicare Part D, the three most important terms you need to know about are formulary, tiers and pharmacy network.

Formulary: Each Part D plan has a formulary, which is a list of covered drugs. It includes a wide range of prescription medications categorized into different tiers.

Tiers: Each tier has a different cost-sharing amount for medications. Lower tier drugs usually have lower copayments or coinsurance.

Pharmacy network: Part D plans have a network of pharmacies where members can fill their prescriptions. It is important to choose a plan with pharmacies that are convenient for you.

Not all plans have the same formularies, tiers and pharmacy networks in place, so it’s important to pick a plan that covers all your needs.

What changes were implemented in 2025?

Three important changes will be made:

1. Annual out-of-pocket costs for Medicare Part D are now capped at $2,400.
2. Medicare prescription drug plans must offer the option for members to pay out-of-pocket costs in monthly installments instead of all at once at the pharmacy.
3. The Coverage Gap Discount Program has been replaced by a Part D manufacturer discount program, and the coverage gap stage, commonly known as the “donut hole,” has been eliminated from Medicare Part D plans.

Who was affected by the changes?

Most people enrolled in Medicare were affected by the changes made to Medicare Part D. Check with your Medicare plan provider to learn how your coverage may have changed.

Where can I learn more about the changes to Medicare and my plan options?

Whether you’re new to Medicare or exploring your options, we understand that you need a plan with benefits and support tailored to you and your health goals. Align powered by Sanford Health Plan offers free resources to help you learn about your Medicare options, including a prescription coverage guide.

We also offer Medicare Advantage plans that include Medicare Parts A & B, prescription coverage and extra benefits. Plus, you’ll receive care from a network of providers you know and trust.

Our plans include:

• $0 primary care copays
• $0 medical deductibles
• $0 select prescription drug copays
• $0 preventive care services

Plus extra benefits:

• Dental, vision and hearing
• Over-the-counter benefits
• Fitness incentives
• Health navigator services

To download our free prescription coverage guide or learn more about prescription coverage changes, visit our Part D resource page.

Align powered by Sanford Health Plan is a PPO plan with a Medicare contract. Enrollment in Align powered by Sanford Health Plan depends on contract renewal. Sanford Health complies with applicable federal civil rights laws and does not discriminate, exclude or treat people differently based on race, color, national origin, religion, pregnancy and related conditions, sex (including sexual orientation, gender identity, sex stereotypes, sex characteristics and intersex traits), age, disability, health status, marital status, arrest or conviction record or military participation in the administration of the plan, including enrollment and benefit determinations. Free interpretation services are available to you. Additional services and resources necessary to provide information on accessible formats are also available at no cost. Call (877) 509-4979 (TTY: 711) or speak with your healthcare provider. Spanish: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. También están disponibles de forma gratuita ayuda y servicios auxiliares apropiados para proporcionar información en formatos accesibles. Llame al (877) 509-4979 (TTY: 711) o hable con su proveedor. Oromo: Yoo afaan Oromoo dubbattu ta'e, tajaajilli gargaarsa afaanii bilisaa siniif ni argama. Gargaarsi gargaaraa fi tajaajilli sirrii ta’ee fi odeeffannoo bifa dhaqqabamaa ta’een kennuunis bilisaan ni argama. Bilbilaa (877) 509-4979 (TTY: 711) yookiin dhiyeessaa kee waliin haasa'aa. If you require large-print materials, please call (877) 509-4979 (TTY: 711).

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Last Updated On: 9.24.26 at 10:30 AM