Medicare Part D Plans: Compare Your Prescription Costs

Compare Medicare Part D plans by the estimated cost of a full year of premiums and prescriptions at pharmacies you can use. Start with your exact medications, then check coverage restrictions and pharmacy prices. Medicare’s comparison tools can estimate monthly and yearly costs from your drug list.

Make sure you need a stand-alone drug plan

A stand-alone prescription drug plan, or PDP, adds Part D coverage to Original Medicare. Part A is hospital insurance; Part B is medical insurance. You need Part A or Part B to join a PDP, and you must live in its service area and meet Medicare’s other enrollment requirements.

Medigap, also called Medicare Supplement insurance, helps pay certain Original Medicare expenses. Policies sold today do not include prescription drug coverage. If you are adding Part D to Plan G or Plan N, compare the drug plan separately from the supplement: the Medigap letter does not determine your drug formulary or pharmacy costs.

Medicare Advantage with prescription coverage, often called MA-PD, combines medical and drug benefits. It remains an Advantage product. Joining a separate PDP while enrolled in an Advantage HMO or PPO generally disenrolls you from that Advantage plan and returns you to Original Medicare. Confirm the effect before enrolling.

Build a comparison around your prescriptions

Have these details ready:

• Your ZIP code, county and intended coverage year.
• Every prescription’s name, brand or generic version, strength and dosage form.
• Quantity per refill, how often you take it and the number of days each refill lasts.
• Your regular pharmacy’s exact location, a practical alternative and whether mail order works for you.
• Your current plan and any Extra Help or other drug coverage.

Use the same entries for every plan. A tablet and an extended-release tablet are not interchangeable shopping entries. Include occasional prescriptions you expect to refill, and ask your prescriber to resolve uncertainties about the medication list.

Enter that information in Medicare Plan Finder and compare stand-alone drug plans for your area. Shortlist plans that fit your medications and pharmacy needs, then review their current formulary, pharmacy directory and Evidence of Coverage. Estimates are a planning tool; changes to prescriptions, prices or coverage can change what you actually spend.

Wellcare and Aetna’s SilverScript publish stand-alone Part D shopping information. Treat those names as starting points: compare the exact local plan and year, and never infer a drug’s coverage from the carrier name.

Compare annual spending and early-year bills

A copayment is a fixed charge; coinsurance is a percentage of the drug cost. Compare dollar estimates when evaluating a plan that uses coinsurance.

For each finalist, add 12 months of plan premiums to estimated out-of-pocket costs for covered prescriptions. Include deductible spending in that drug estimate; do not add the deductible a second time. Budget separately for uncovered prescriptions and any applicable income-related Part D surcharge or late-enrollment penalty.

Hypothetical example, not available quotes: a plan with $120 in annual premiums and $900 in estimated drug costs totals $1,020. Another with $480 in premiums and $400 in drug costs totals $880. Under those assumptions, the higher-premium plan costs $140 less.

Check the Part D deductible and annual cap for the year you are buying:

These are federal limits, not premium quotes. Some plans have lower deductibles or no deductible. For 2027, the maximum deductible is $700 and the annual out-of-pocket limit for covered Part D drugs is $2,400; these limits do not establish a particular plan’s premium or formulary.

Your covered-drug deductible, copayments and coinsurance count toward the cap, along with certain qualifying payments made for you. Premiums, noncovered drugs and drugs paid under Part A or Part B do not. Once the threshold is reached, covered Part D drugs have no further cost sharing that calendar year. The deductible is part of the limit, not an extra amount above it.

Also review monthly estimates. The Medicare Prescription Payment Plan can spread covered-drug out-of-pocket payments across the calendar year, but it does not reduce the total owed. If income and resources are limited, check Extra Help before comparing your final costs.

If you take few or no prescriptions

Part D choices with few prescriptions deserve a comparison of premiums, pharmacy access and costs for the medicines you do take. A low-premium plan can be a reasonable starting point; paying more needs a reason tied to your needs.

Taking no prescriptions does not remove the enrollment decision. After your Initial Enrollment Period, going 63 consecutive days or more without Part D or other creditable drug coverage can trigger a penalty when you later enroll. It generally continues for as long as you have Part D.

Creditable coverage is expected to pay at least as much, on average, as Medicare drug coverage. If you have employer, retiree, VA or TRICARE benefits, check your coverage notice and consult the benefits administrator before changing coverage. Discount cards are not drug insurance.

Check how each drug is covered

A formulary is the plan’s covered-drug list. Its tiers affect what you pay, and plans can assign different costs to different drugs. Check the current document rather than relying on last year’s coverage.

Look for three restrictions:

• Prior authorization: approval is needed before coverage.
• Step therapy: another treatment generally must be tried first.
• Quantity limits: the plan limits the amount covered over a specified period.

Ask whether your prescription fits those rules and what your prescriber would need to submit.

For someone taking Eliquis, comparing Part D coverage for Eliquis means matching the prescribed strength and quantity, checking the current formulary entry and restrictions, and pricing it at the intended pharmacy. Add every other medication before choosing: the lowest estimate for one prescription may not produce the lowest combined annual bill.

Check insulin separately from other diabetes costs

Part D insulin coverage and total costs require checking your specific insulin product and delivery method. For each insulin product covered by your plan, a one-month supply costs no more than $35, and the deductible does not apply. Your charge may be lower. This is not a $35 ceiling for all diabetes care.

Insulin used in a pump covered under Part B’s durable medical equipment benefit falls under Part B. Part D may cover injectable insulin, insulin for certain other pumps and injection supplies. Price your other diabetes drugs and supplies separately under the appropriate coverage.

Price the same drugs at practical pharmacies

When comparing pharmacies under Part D, check whether each exact location is preferred, standard in-network or out-of-network for the plan. Preferred pharmacies usually have lower drug costs; an out-of-network fill may leave you paying the full price.

Compare your full list at your usual pharmacy and at least one convenient alternative. Check retail and mail-order options for longer supplies when available, using the same number of covered days. Consider travel time, delivery reliability and refill coordination alongside price.

If a discount-card price looks attractive, remember that purchases made through a discount program instead of your Medicare plan do not count toward your Part D deductible or out-of-pocket limit. Compare the annual effect as well as today’s receipt.

Resolve coverage problems before committing

Your options when Part D does not cover a drug begin with identifying the problem: a missing formulary entry, a coverage restriction or a pharmacy billing issue.

Ask the plan and pharmacist to check the exact prescription. Then ask your prescriber about covered alternatives or a formulary exception. An exception requires the prescriber’s supporting medical explanation; approval is not automatic. If denied, the decision explains how to appeal.

When new coverage begins, a temporary transition fill may be available for an existing medication. Ask promptly; it is not permanent approval. Changing plans requires an applicable enrollment period, so do not assume a denied prescription lets you switch immediately.

Match your choice to an enrollment window

For most people first eligible at 65, the Initial Enrollment Period includes the three months before their birthday month, that month and the following three months. Medicare eligibility through disability or other circumstances can change the timing.

Annual Medicare Open Enrollment runs October 15–December 7, with changes effective January 1. Thus, fall 2026 shopping is for 2027 coverage. Use 2027 plan documents and your Annual Notice of Change when reviewing renewal. The January 1–March 31 Medicare Advantage Open Enrollment Period is not a general switching window for people with Original Medicare and a PDP.

Moving or losing creditable drug coverage may create a Special Enrollment Period; deadlines depend on the event. Annual Medicare Open Enrollment also does not generally guarantee access to Medigap without medical underwriting. Federal protections and additional state rights must be checked separately.

Prepare your final comparison

For personalized Medicare Part D comparisons, assemble your complete drug list, dosages, refill quantities, pharmacies, ZIP code and coverage year. Compare the best-fitting two or three plans over the same full calendar year; if enrolling midyear, also request a remaining-year estimate.

Before choosing, confirm each essential drug’s coverage, unresolved restrictions, pharmacy status, annual premium-plus-drug estimate and coverage start date. Save the plan name, plan ID, dated estimate and supporting documents. Choose with those details in hand.