Medicare Part D plans, checked one prescription at a time
Here's how I'd look at drug coverage: on its own or inside a Medicare Advantage plan, checking each drug against a plan's list, and knowing when the late penalty applies.
Jeannie Pond, Licensed Insurance Agent, NPN 8940178, licensed since 2009
No ofrecemos todos los planes disponibles en su área. Actualmente representamos 14 organizaciones que ofrecen 52 productos en su área. Comuníquese con Medicare.gov o llame al 1-800-MEDICARE para obtener información sobre todas sus opciones.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, las 24 horas del día, los 7 días de la semana
Medicare drug coverage (Part D) helps cover the cost of prescription drugs. You get it from a private plan that contracts with Medicare, either as a separate drug plan beside Original Medicare or inside most Medicare Advantage Plans. Each plan has its own list of covered drugs, called a formulary, so check every drug you take on Medicare.gov, and ask your pharmacy whether it's in the plan's network.
Drug coverage: the checks, in order
- Before you joinThe plan's drug list
- Before you joinYour pharmacy
- Each fallThe yearly review
- October 15 to December 7The Open Enrollment Period
You make every check on Medicare.gov, at your pharmacy or with your plan's own notice.
On its own, or inside a Medicare Advantage Plan
A separate Medicare drug plan
Adds drug coverage to Original Medicare. You need Part A, Part B or both to join one.
Inside a Medicare Advantage Plan
You get Part A, Part B and your drug coverage through one plan, and most Medicare Advantage Plans include it. You need both Part A and Part B to join.
If your Medicare Advantage HMO Point-of-Service or PPO plan doesn't cover drugs, you can't add a separate drug plan: joining one disenrolls you from the Medicare Advantage Plan and returns you to Original Medicare.
How Medicare Advantage plans work, and what they tradeHow a plan's drug list works
Each plan has its own list of covered drugs, called a formulary, and lists vary in cost and in the specific drugs covered. That's why the same prescription can be handled differently from one plan to the next.
What every plan must cover
All plans must cover a wide range of prescription drugs that people with Medicare take, including most drugs in certain protected classes, like drugs to treat cancer, HIV/AIDS or depression. Plans cover a variety of brand-name and generic drugs.
Tiers set your share
Plans divide the drugs on their formulary into groups called tiers, based on cost. A drug in a lower tier will cost less than a drug in a higher tier, so note the tier of each drug you take.
The plan's own rules
Drug plans also have rules: guidelines they use to manage costs and keep you safe. In a Medicare Advantage Plan, you may need approval (prior authorization) for certain drugs before you get them.
Ways to lower what you pay
Ask your doctor whether you can take a generic drug, or a cheaper brand-name drug if one's available. It's also worth checking costs at mail-order pharmacies, which are sometimes cheaper.
Source: Medicare.gov, What do drug plans cover, Your coverage options, Parts of Medicare and Help with drug costs, 2026.
Creditable coverage, and when a late penalty applies
Creditable drug coverage
Drug coverage that's expected to pay, on average, at least as much as Medicare drug coverage. It may come from a current or former employer or union, TRICARE, the VA or the Indian Health Service. Your plan must tell you each year whether your coverage is creditable, so keep those letters.
The late enrollment penalty
If, after your Initial Enrollment Period, you go sixty-three days or more in a row without Medicare drug coverage or other creditable coverage, a penalty may be added to your monthly premium for as long as you have Medicare drug coverage. It's one percent of the national base beneficiary premium for each full month you went without.
State of Florida retirees in the state health plan
- State retirees in the state secondary health plan should not add a separate Part D plan; the state drug coverage is creditable.
- A State of Florida retiree who buys private Part C, Part D or Medigap coverage should cancel the state group plan, and once cancelled it cannot be rejoined.
Source: Division of State Group Insurance, MyBenefits, 2026.
Medicare for Florida Retirement System retireesExtra Help with drug costs
Extra Help is a Medicare program that helps people with limited income and resources pay drug coverage costs. Its rules and limits are set and updated by Medicare and Social Security. My guide to Medicare Extra Help walks through who gets it automatically, this year's limits and how to apply.
Who qualifies
It depends on your income and resources, and the limits may go up each year. Medicare.gov lists the current limits.
Where to apply
You apply through Social Security. Your State Health Insurance Assistance Program (SHIP) can also help you apply.
Sources: Medicare.gov, Help with drug costs, 2026; Social Security, Apply for Medicare Part D Extra Help, 2026.
My licenses, so you can look me up
Jeannie Pond is a licensed health insurance agent in Florida.
Jeannie Pond ayuda a sus clientes con planes Medicare Advantage, el Seguro Suplementario de Medicare y planes de medicamentos recetados de la Parte D.
Jeannie Pond, Licensed Insurance Agent, NPN 8940178. Florida W272782; Arizona 8940178; California 4524185; Georgia 2669678; Indiana 4017600 (health only); Michigan 8940178; New Jersey 3004406991; North Carolina 8940178; Tennessee 960426; Texas 1617709; Virginia 1447142 (health only); Washington 1346341.
Vista Consultants LLC dba Vista Insurance Services holds Florida insurance agency license L135539 (agency NPN 22164003), issued March 19, 2026, with Jeannie Pond as agent in charge.
Every kind of coverage, explainedCommon Part D questions
How is drug coverage different in a Medicare Advantage plan and a stand-alone Part D plan?
A stand-alone Medicare drug plan adds drug coverage to Original Medicare, and you need Part A, Part B or both to join it. A Medicare Advantage Plan gives you Part A, Part B and usually drug coverage in one plan, and you need both Part A and Part B to join. If your Medicare Advantage HMO Point-of-Service or PPO plan doesn't cover drugs, you can't add a separate drug plan; joining one disenrolls you from the Medicare Advantage Plan. Either way, each plan has its own list of covered drugs. (Source: Medicare.gov, Choose how you get drug coverage and What do drug plans cover, 2026.)
How much does Medicare Part D cost?
It depends on the plan you choose. You may pay a monthly premium, which can be higher depending on your income; a yearly deductible, which no Medicare drug plan may set above $615 in 2026, and some plans have none; and a copayment or coinsurance for each drug. A late enrollment penalty, if you owe one, is added to the premium. (Source: Medicare.gov, How much does Medicare drug coverage cost, 2026.)
Is Medicare Part D worth it if I don't take many drugs?
Even if you don't take many drugs now, or your drug costs are low, Medicare.gov suggests considering a drug plan with a low monthly premium so you avoid the late enrollment penalty, which is added to your premium for as long as you have Medicare drug coverage. The exception is creditable drug coverage, like coverage from a current or former employer or union: you typically don't need Medicare drug coverage while you keep it. (Source: Medicare.gov, How much does Medicare drug coverage cost and Creditable prescription drug coverage, 2026.)
What counts as creditable drug coverage?
Prescription drug coverage that's expected to pay, on average, at least as much as Medicare drug coverage. It may come from a current or former employer or union, TRICARE, the VA or the Indian Health Service, and your plan must tell you each year whether it's creditable. Doctor samples, discount cards and drug discount websites aren't drug coverage. For State of Florida retirees in the state secondary health plan, the state says its drug coverage is creditable. (Sources: Medicare.gov, Creditable prescription drug coverage, 2026; Division of State Group Insurance, MyBenefits, 2026.)
Have a drug coverage question? Ask me.
Leave your name and number, and I'll get back to you. You can also call me.Medicare help in Lakeland and nearby cities
Jeannie Pond, Licensed Insurance Agent, NPN 8940178, licensed since 2009
No ofrecemos todos los planes disponibles en su área. Actualmente representamos 14 organizaciones que ofrecen 52 productos en su área. Comuníquese con Medicare.gov o llame al 1-800-MEDICARE para obtener información sobre todas sus opciones.
1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048, las 24 horas del día, los 7 días de la semana