Medicare Part D · Florida
The plan you pick by premium is rarely the plan that costs you the least.
Medicare Part D plans cover prescription drugs. They look similar at first glance, but the differences in covered drug lists and tier pricing can produce wildly different annual costs for two people on the same medications.
Choosing a Part D plan well is mostly about matching the plan's formulary to the specific medications you take — not picking the lowest premium and hoping.
How it works
The basics of Part D.
Part D is the part of Medicare that covers prescription drugs. It is not included in Original Medicare or in a Supplement plan. You buy a stand-alone Part D plan from a private insurer if you have Original Medicare, or you get drug coverage bundled into a Medicare Advantage plan.
Each Part D plan has a formulary — a list of drugs the plan covers, organized into tiers. Tier 1 drugs (typical generics) have the lowest copays. Tier 5 specialty drugs have the highest. The exact drugs in each tier vary plan to plan, which is why two plans with the same premium can produce very different costs depending on what you actually take.
Starting in 2025, Medicare prescription drug coverage has a $2,000 annual out-of-pocket cap on covered drugs. Once you hit the cap, the plan covers 100% of covered drug costs for the rest of the year. This is a meaningful improvement from previous years for people on expensive medications.
The mistake to avoid
Why the lowest-premium plan is rarely the cheapest.
Two Part D plans, both available in your zip code. Plan A has a $7 monthly premium. Plan B has a $35 monthly premium. The obvious choice is Plan A — until you check the formulary.
On Plan A, your blood pressure medication is on Tier 3 with a $47 copay. On Plan B, the same medication is on Tier 1 with a $5 copay. Across a year — twelve months of premium plus twelve months of copays — Plan B costs less despite the higher monthly premium.
This is the most common mistake people make in Part D selection. The plan finder on Medicare.gov can do the math, but it requires entering every medication, every dose, every pharmacy, and reviewing the results carefully. We do this for clients during the consultation rather than letting people guess.
Questions
Common questions about Part D
Do I need Part D if I do not take any prescriptions?
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In most cases, yes. If you do not enroll in a Part D plan when you first become eligible, you can be charged a permanent late enrollment penalty when you do enroll later — usually 1% of the national base premium for every month you went without coverage. The penalty is added to your premium for life. Even people who take no medications today often enroll in a low-cost Part D plan to avoid the penalty and have coverage in place if they need it later.
How are Part D plans different from each other?
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Three things vary: the monthly premium, the deductible, and the formulary (the list of covered drugs). The same medication can be on Tier 1 in one plan and Tier 4 in another, with very different copays. The cheapest plan by premium is rarely the cheapest plan in total cost once your specific medications are factored in. We run your medication list against multiple plans to find the lowest annual total cost, not just the lowest premium.
When can I change my Part D plan?
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During the Annual Election Period, October 15 to December 7 each year. The new plan takes effect January 1. Outside this window, changes are limited to specific Special Enrollment Period circumstances — moving, losing other drug coverage, qualifying for Extra Help, and a few others. We recommend reviewing your Part D plan every year because formularies and pricing change, and the plan that was best for you this year may not be next year.
What is the donut hole?
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It used to be a coverage gap where you paid a higher share of drug costs after your total spending hit a threshold. Federal law has substantially closed the gap, and starting in 2025, Medicare drug coverage has a $2,000 annual out-of-pocket cap on covered prescriptions. Once you hit the cap, you pay nothing more for covered drugs the rest of the year. This is a significant change from previous years and benefits people on expensive medications.
Next step
Run your medication list against the available plans.
We compare the all-in annual cost of every Part D plan available in your zip code against the specific medications you take. The right plan is rarely the cheapest premium.