Medicare Part D’s drug coverage is a crucial aspect of health insurance for retirees. Those with stand-alone Part D plans have various options, and these plans can change significantly from one year to the next, which might mean that switching plans could lead to considerable savings.
Features of these plans might include premiums, deductibles, copays, pharmacy networks, and covered medications. So, a plan that worked for you in 2025 might not be the best fit in 2026.
During the fall open enrollment period for Medicare, spanning from October 15 to December 7 annually, enrollees have the chance to evaluate their coverage and change plans if they wish.
How does drug coverage fit into Medicare?
Navigating Medicare can be a bit tricky. Original Medicare provides coverage for hospital and medical services but doesn’t cover prescription drugs. There are a couple of common ways to obtain drug coverage. One option is to select a Medicare Advantage plan, which is an alternative to Original Medicare that often includes drug coverage. The second option is sticking with Original Medicare and opting for a standalone Part D plan. About one-third of beneficiaries prefer this latter path, so it’s necessary for beneficiaries to evaluate their choices annually.
Select a standalone Part D plan
Different insurance companies provide varying levels of drug coverage, so exploring different policies can be advantageous. The Medicare Plan Finder Tool Medicare.Government simplifies this process. You can log in to save information or browse options without logging in. The steps for searching are:
- First, enter your postal code.
- Next, input the names, dosages, and how often you use your current medications. Costs can significantly differ based on the drug, making this information essential for choosing the right plan.
- Then, add the name of your preferred pharmacy. Part D plans often feature preferred pharmacies with reduced copays.
- The tool will then show available drug plans, outlining monthly premiums, total deductibles, and estimated total annual costs for prescriptions and premiums.
Click on Plan Details to understand how estimated costs are calculated. Are your medications included? How much will your monthly premium shift? What might your expected monthly out-of-pocket costs be? It’s wise to avoid choosing a plan based on monthly premiums alone; considering all costs, including out-of-pocket expenses, is generally more beneficial.
Once a plan is selected, you can apply immediately on the website. You’ll likely need to provide your Medicare number and other health insurance details, and specify when the changes will take effect (usually January 1, 2026, if you switched during the fall open enrollment).
Why go through all the trouble?
If you already have a Part D plan, you might think it’s easier to stay with it. However, costs and coverage can fluctuate each year.
For instance, any plan’s list of covered drugs may change annually, with medications being added or removed, or moved to different cost tiers, alongside new restrictions like prior authorization. Plans may also adjust monthly premiums, deductibles, and copays, impacting your expected costs even if you remain on the same medications.
Moreover, new plans are introduced yearly while older ones may be phased out. By assessing alternatives, you can steer clear of outdated or overly expensive plans.
If you’re starting a new prescription, exploring new options can help you find a plan that covers those medications at a lower total cost.
Those I assist in evaluating their options often save around $600 annually, depending on their circumstances and medications. Data from KFF indicates that nearly half of beneficiaries who changed to a new Part D plan saw a drop of at least 5% in their costs the following year.
Even if your prescription regimen stays the same, reviewing your plan during the open enrollment can help ensure you maintain drug coverage effectively and manage costs better. A simple check on Medicare’s website can make a significant difference in your expenses for the upcoming year.
