Medicare prescription deductibles: 3 things to check first

Sticker shock at the pharmacy? You’re not alone. If you’ve ever wondered why your medication costs are so much, your Medicare prescription deductible could be the reason.

Understanding how Medicare prescription deductibles work can help you avoid surprise costs at the pharmacy and choose the right health plan for your needs.

In this article, you’ll learn more about Medicare prescription deductibles and three things to look for to help you choose a plan.

What is a Medicare prescription deductible?

A Medicare prescription deductible is the amount you must pay out of pocket for medications before your insurance starts covering costs.¹

Some Medicare plans combine prescription and medical expenses into one deductible, while others keep them separate.

Medicare Part D & prescription deductibles

Medicare Part D, the prescription drug plan for Medicare enrollees, has strict rules on deductibles. In 2025:

No plan can have a deductible higher than $590. Some plans have lower deductibles or none at all.²
Medicare Part D beneficiaries won’t pay more than $2,000 out-of-pocket for covered prescription drugs in a calendar year.

Trouble paying for prescription medications?

If you find it hard to pay for prescription medications, you may qualify for the Medicare Part D Extra Help program.²

Programs like Extra Help won’t lower your Medicare prescription deductible, but they can help reduce your premiums and copays, if you qualify. If you’re having trouble affording prescriptions, it’s worth looking into.

3 Medicare prescription deductible details to check

When comparing Medicare drug plans, here are three key deductible details to consider:

1. Is the prescription deductible combined or separate from your health coverage?

This affects how your medical and drug costs count toward your out-of-pocket limit.

2. What is the prescription deductible amount?

Plan deductibles can range from $0 to $590 in 2025. A lower deductible may mean earlier cost-sharing for prescriptions.⁴

3. Is a separate drug deductible better for your needs?

If you don’t use many medical services but take regular medications, a plan with a separate (and lower) drug deductible might help you.

Let’s take a closer look at these options…

Choosing a plan: Combined vs. separate Medicare prescription deductibles

When reviewing your plan options, pay attention to how the Medicare prescription deductible is structured.

Here are two common types:

1. Combined Medicare prescription deductibles

A combined deductible means both medical and prescription costs count toward the same total. Once you reach that amount, your plan starts covering expenses at its designated rate.

Here’s an example:

Joe’s health plan has a $3,000 combined deductible.
He spends $2,750 on a minor surgery and $250 on prescriptions.
Since his deductible is met, Joe now pays $10 per refill for his generic medication.

2. Separate Medicare prescription deductibles

A separate prescription deductible applies only to medication costs. Other medical expenses, like doctor visits, don’t count toward it.

Here’s an example:

Joe’s plan has a $3,000 medical deductible and a $250 separate prescription deductible.
Joe hasn’t met his medical deductible, but does needs to pay $250 for prescriptions before his plan starts covering them.
Once he meets this, he pays $10 per refill for his generic medication.

Other ways to lower prescription medication costs

Regardless if you have a combined or separate prescription deductible there are several more ways to help lower your out-of-pocket costs, including:

Using coupons from drug manufacturers
Switching to generic medications
Using funds from a Health Savings Account (HSA). If you had an HSA before enrolling in Medicare, you can still use the money tax-free for qualified medical expenses, including prescriptions. Just keep in mind that you can’t add new contributions to your HSA once you’re on Medicare.³

Looking for a plan with a $0 prescription deductible that fits your needs?

Comparing prescription deductibles is just one part of picking a health plan to meet your needs. With a little help, you may avoid unexpected costs, review your options and find a plan that works for you.

Just give us a call at (800) 827-9990 to speak with a licensed health insurance agent or find a licensed health insurance agent in your area.