FAQ & plain-English terms
Medicare uses a lot of jargon. Here's what the terms in the drug checker mean. Short answers now; fuller articles are on the way.
Plan types: MA-PD vs PDP
- MA-PD — a Medicare Advantage plan that includes drug coverage. It's an all-in-one plan (medical + drugs) that replaces Original Medicare, usually run by a private insurer.
- PDP — a stand-alone Prescription Drug Plan you add on top of Original Medicare, just for drug coverage.
Full article coming soon.
Premium, deductible, copay, coinsurance
- Deductible — what you pay out of pocket for drugs each year before the plan starts sharing the cost.
- Copay — a fixed dollar amount per fill (for example, $10).
- Coinsurance — a percentage of the drug's price per fill (for example, 25%) instead of a flat dollar amount. Because it depends on the drug's price, the checker shows it as a % and can't total it into your annual estimate.
Full article coming soon.
Coverage phases
Medicare Part D cost-sharing changes in phases as your drug spending adds up over the year. Which phase you're in depends on how much you've spent so far — which is personal, so the checker shows the plan's listed cost for each phase, not your live phase.
- Pre-deductible — early in the year, before you've met the plan's deductible. You may pay more (sometimes the full price) here.
- Initial coverage — your regular copay or coinsurance after the deductible is met. This is the headline number in the checker.
- Catastrophic — once your yearly out-of-pocket spending reaches the cap ($2,000 in 2025), covered drugs are $0 for the rest of the year. (The old "donut hole" coverage gap was removed in 2025.)
Full article coming soon.
Pharmacy type: standard, preferred, and mail
Where you fill a prescription changes the price on the same plan.
- Standard retail — any in-network pharmacy.
- Preferred retail — specific pharmacies the plan designates as lower-cost. Same drug, often a smaller copay.
- Preferred mail — the plan's mail-order pharmacy. Often the cheapest option, especially for 90-day supplies.
Full article coming soon.
Days supply (30-day vs 90-day)
How many days each fill covers. A 90-day fill often costs less per month than three 30-day fills — particularly by mail. The checker's headline uses a 30-day fill; the expandable detail shows 90-day too.
Full article coming soon.
Tiers and the PA / ST / QL flags
Plans sort drugs into tiers (lower tiers usually cost less). Some drugs carry restrictions: PA = prior authorization (the plan must approve it first), ST = step therapy (try a preferred drug first), QL = quantity limit (a cap on how much is covered per fill).
A plan's formulary is its official list of covered drugs. If your drug isn't on it, the checker says "Not covered by this plan's formulary" rather than hiding the plan.
Full article coming soon.