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Questions? Call (918) 420-9999
Prescription Drug Plans, Made Simple
Medicare Part D helps pay for the medications your doctor prescribes — something Original Medicare doesn't cover on its own. Whether you're comparing standalone drug plans or checking what's bundled into a Medicare Advantage plan, here's what you need to know for 2026, including how Extra Help can lower your costs if you qualify.
Why You Shouldn't Skip Part D
Original Medicare doesn't cover prescription drugs, and going without creditable drug coverage can cost you later — even if you don't take many medications right now.
Maybe this sounds familiar:
• "I don't take many prescriptions, so I figured I could skip it."
• "I didn't realize there was a penalty for enrolling late."
• "I don't know the difference between a standalone plan and one bundled into Advantage."
• "I'm worried my medications won't be covered, or will cost more than expected."
None of that means you're behind. It means no one has walked you through how Part D actually works yet — including the penalty for waiting and the ways to lower your costs if money is tight.
Two Ways to Get Part D Coverage
There's no single "Part D plan" — you get drug coverage one of two ways, and it's worth knowing the difference before you enroll.
Standalone Prescription Drug Plans (PDP)
A standalone PDP adds drug coverage on top of Original Medicare (Parts A & B). This is the right fit if you have Original Medicare, or a Medicare Supplement plan, and just need coverage for your prescriptions. Plans vary by which drugs they cover (their "formulary"), monthly premium, and pharmacy network — so it pays to compare before you enroll.
Part D Bundled Into Medicare Advantage
Most Medicare Advantage plans include Part D drug coverage built right in — this is called a Medicare Advantage Prescription Drug (MA-PD) plan. If you go this route, your medical and drug coverage come from the same plan, often for one combined monthly premium. It's a convenient option, but it's worth checking that your specific medications are on the plan's formulary.
What Part D Actually Costs in 2026
In 2026, all Part D plans (standalone and Medicare Advantage) follow the same standard cost structure, broken into stages:
• Deductible — up to $615 before your plan starts sharing costs (some plans have a lower or $0 deductible)
• Initial coverage — you pay 25% of the cost for covered drugs, your plan pays the rest
• Out-of-pocket cap — once you've spent $2,100 total on covered drugs in the year, you enter catastrophic coverage
• Catastrophic coverage — after that, you pay $0 for covered Part D drugs for the rest of the year
If money is tight, the Extra Help program below can lower or eliminate these costs entirely.
Extra Help: Lower Your Drug Costs in 2026
Who Qualifies for Extra Help
Extra Help (also called the Part D Low-Income Subsidy) is a federal program that helps pay your Part D premium, deductible, and copays. Here's what qualifies in 2026:
| Single | Married | |
|---|---|---|
| Monthly Income | $2,015≈150% of poverty level | $2,725≈150% of poverty level |
| Annual Income | $24,180 | $32,700 |
| Resource Limit | $16,590savings, stocks & bonds | $33,100savings, stocks & bonds |
| With Burial Exclusion | $18,090up to $1,500/person set aside | $36,100up to $1,500/person set aside |
What Extra Help Covers, and How to Apply
If you qualify, Extra Help can cover: your Part D monthly premium (up to your region's benchmark amount), your $0 annual deductible, and reduced copays — as low as $1.60 for generic drugs and $4.90 for brand-name drugs (or $5.10/$12.65 if your income is 100–150% of the poverty level). To apply, contact Social Security at ssa.gov/extrahelp, call 1-800-772-1213 (TTY 1-800-325-0778), or visit your local Social Security office. There's no deadline — you can apply any time, and if you qualify, you can also get help choosing a plan that fits your medications.
Still Not Sure Which Drug Plan Is Right for You?
Whether it's a standalone plan, a plan bundled into Medicare Advantage, or figuring out if you qualify for Extra Help, we can walk through your specific medications and budget together — no pressure, no obligation.
Set up a free appointment and we'll help you find the right fit.
The Part D Late Enrollment Penalty
If you go 63 or more days in a row without Part D or other "creditable" drug coverage after you're first eligible for Medicare, you can be charged a penalty — permanently added to your monthly premium for as long as you have Part D.
Maybe this sounds familiar:
• "I don't take any medications, so I figured I could skip it."
• "I already had employer coverage, so I wasn't sure if I needed to enroll separately."
• "I didn't realize the penalty was permanent, not one-time."
• "No one told me there was a deadline to worry about."
The penalty is roughly 1% of the "national base beneficiary premium" for every month you went without creditable coverage, added to your premium for life. Extra Help (covered below) can also help offset this if you qualify.
How to Avoid the Penalty and Find Coverage
You won't owe a penalty if you enroll in a Part D plan (standalone or through Medicare Advantage) during your Initial Enrollment Period, or if you have other creditable coverage — like from an employer or union — that's at least as good as Medicare's. If you're losing other coverage, you typically get a Special Enrollment Period to sign up for Part D without a gap.
When to Enroll in Part D
Your Initial Enrollment Period runs 7 months — starting 3 months before you turn 65, including your birthday month, and ending 3 months after. After that, you can join, switch, or drop a Part D plan during Fall Open Enrollment (October 15 – December 7) each year, with changes taking effect January 1.
Comparing Plans and Checking Your Formulary
Every Part D plan has a "formulary" — a list of covered drugs, sorted into tiers that determine your copay. Before you enroll, check that your specific medications are covered, at what tier, and whether your regular pharmacy is in the plan's network. Premiums and total costs can vary widely between plans covering the exact same drugs.
Common Part D Questions
A few questions we hear often:
• "Can I switch plans if my medications change?" — Yes, during Fall Open Enrollment each year, or sooner if you qualify for a Special Enrollment Period.
• "Does Part D cover vaccines?" — Most vaccines are covered under Part D at no cost to you, thanks to recent changes to the program.
• "What if I have both Medicare and Medicaid?" — You likely qualify for Extra Help automatically, and may be enrolled in a Part D plan for you.
• "Can I have a standalone plan and Medicare Advantage at the same time?" — No — enrolling in an MA-PD plan or a standalone PDP with a Medicare Advantage plan that already includes drug coverage can drop you from your Advantage plan, so check before you switch.
Quick Recap: PDP vs. MA-PD
Standalone Plans (PDP)
Best if you're happy with Original Medicare (or a Medicare Supplement plan) and just need to add drug coverage. You pick your drug plan independently — the coverage isn't tied to a medical plan.
Bundled Plans (MA-PD)
Best if you'd rather have one plan and one card for both medical and drug coverage. Just double-check your medications are on the plan's formulary before you enroll, since coverage varies by plan.
You Don't Have to Sort This Out Alone
Work with a Local Expert
You could spend weeks cross-checking articles and still wonder what you missed. Or you could sit down with someone who explains this every day. We're education-first — our job is to help you understand your options before you ever choose a plan. No pressure, no obligation, and our guidance doesn't cost you anything. You ask the questions; you decide what happens next.
Ready to Find Your Part D Plan?
Whether you need a standalone plan, want drug coverage bundled into Medicare Advantage, or think you might qualify for Extra Help, we'll walk through your medications and budget with you — free, no obligation.
Let's find the plan that fits your prescriptions and your wallet.
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