How to Pick the Right Medicare Part D Plan: Key Considerations for 2026

In 2026, some Medicare Part D Plans saw dramatic rate increases.

With the cost of medications always on the rise, you can’t afford to just enroll in any Medicare Part D Plan. If you’re not careful, you could end up on the hook for expensive bills. 

That’s why in this article, we’ll go over how to find the right Medicare Part D Plan for your unique situation, and the key factors that determine which plan is the right fit for you. 

We’ll go over:

• Things to consider while choosing a plan
• How to lower your Medicare Part D costs
• How to find Medicare Part D plans available in your area
• Frequently asked questions about Medicare Part D

Before We Begin: Understanding Medicare Part D Basics

What is Medicare Part D?

Medicare Part D is the prescription drug coverage part of Medicare. Private insurance companies sell Medicare Part D plans, which you enroll in separately from Original Medicare (Medicare Part A and B). 

What’s the Difference Between PDP and MAPD?

There are two main ways to get a Medicare Part D Plan: a standalone Medicare Part D Prescription Drug Plan (PDP) or a Medicare Advantage Prescription Drug Plan (MAPD). 

• Medicare Part D Prescription Drug Plans (PDP) are sold by private insurance companies working closely with Medicare. People who choose to stay on Original Medicare and get a Medicare Supplement Plan (instead of enrolling in Medicare Advantage) often also enroll in a PDP. 

• Medicare Advantage Prescription Drug Plans (MAPD) are Medicare Advantage Plans that have built-in prescription drug coverage. Most Medicare Advantage Plans today have this. If you enroll in a MAPD, you usually don’t need to enroll in a separate prescription drug plan. 

When Can You Enroll in Medicare Part D?

There are typically three periods when you can enroll in Medicare Part D Plans: your Initial Enrollment Period (IEP), the Annual Enrollment Period (AEP), and Special Enrollment Periods (SEPs). 

• Your Initial Enrollment Period (IEP) for Medicare Part D is the same as your IEP for Original Medicare (Medicare Parts A and B). This typically starts three months before the month you turn 65, and ends three months after the month you turn 65. If your birthday is on the first day of the month, your IEP begins four months before the month you turn 65, and ends two months after the month you turn 65.

Note: if you miss your IEP and don’t have creditable drug coverage from elsewhere, you may be subject to Medicare Part D late enrollment penalties.  

• The Annual Enrollment Period (AEP) runs from October 15 to December 7 every year. During this period, you can enroll in a Medicare Part D Plan (either PDP or MAPD), switch between Part D Plans, or drop your Part D Plan. If you miss your Initial Enrollment Period, this is usually the next time you can enroll. 

• Special Enrollment Periods (SEPs) come up during special circumstances. For example, if you have had creditable drug coverage from elsewhere, you can delay enrolling in Medicare Part D past your Initial Enrollment Period. Once your drug coverage from your other plan ends, you’ll get a Special Enrollment Period to join Medicare Part D that lasts two full months after the month you lose your current plan. 

There are several other Special Enrollment Periods that allow you to enroll in Medicare Part D outside the usual timeframes. 

3 Key Factors When Choosing a Medicare Part D Plan

Not sure how to choose a Medicare Part D Plan? 

Consider these three critical factors: 

#1: Medication Coverage (Drug Formulary)

Generally speaking, Medicare Part D Plans have their own drug formulary, which is a list of drugs that are covered by the plan. Drug formularies not only show you which drugs the plan covers, but they also show how much you have to pay for each particular drug. 

Before enrolling in a plan, it’s critical to check if your prescription drugs are included in the plan’s formulary and how much you have to pay for them. 

If you don’t check the formulary, you may end up with a plan that doesn’t cover your specific medications. Or, you may end up in a plan where you have to pay more expensive copays for your drugs, when other Part D plans in your area might offer your drugs for less. 

#2: Pharmacy Networks

Medicare Part D Plans typically have a network of pharmacies that they work with to provide low-cost drugs. Some plans even have preferred in-network pharmacies that offer the lowest prices. 

However, if you purchase your drugs from a pharmacy that isn’t in your plan’s network, you may have to pay full price — even if the drugs you purchase are included in your plan’s formulary. 

Before enrolling in a plan, make sure to check which pharmacies around you are part of the plan’s network. This way, you won’t find yourself with a plan that only covers pharmacies hours away from where you live. 

Aside from physical pharmacies, many Medicare Part D plans also cover mail-order pharmacies. With these, you can typically have your medications mailed to your address without having to visit a nearby pharmacy. 

#3: Costs (Premiums, Deductibles, and Drug Tiers)

There are generally three costs to consider while choosing a Medicare Part D Plan: premiums, deductibles, and the plan’s drug tiers. 

• Premiums are the monthly cost of the plan. If you enroll in a Medicare Advantage Prescription Drug Plan (MAPD), you generally don’t have to pay a separate premium for your built-in drug plan. Even if your Medicare Advantage Plan has a $0 premium, you won’t normally have to pay extra for drug coverage. 

• A deductible is the amount that you have to pay out of pocket for your prescription drugs before your plan starts covering them. In 2026, Medicare Part D deductibles could range from $0 – $600+. Keep in mind that if you purchase drugs outside of your plan’s formulary, their cost will not count towards your deductible. 

Once you’ve met your plan’s deductible, you move into the initial coverage stage, where drug tiers come into effect. 

• Drug tiers determine the cost-sharing amount for your drugs during the initial coverage stage. Most Medicare Part D Plans divide the drugs they cover into 4-6 tiers, with each tier having a fixed copay or coinsurance amount. 

Lower tiers typically contain generic and cheaper drugs, while the higher tiers usually have brand-name and more expensive drugs. Here’s an example of drug tiers from a hypothetical Medicare Part D Plan: 

Tier:	Cost Sharing:
Tier 1: Preferred generic drugs	$1 copay
Tier 2: Non-preferred generic drugs	$10 copay
Tier 3: Preferred brand-name drugs	$47 copay
Tier 4: Non-preferred brand-name drugs	45% coinsurance

Each plan is free to set its own tiers and cost-sharing amounts, but the example above is how a lot of plans structure their tiers. 

Note: In 2026, once you’ve spent $2,100 out-of-pocket (in the deductible stage and initial coverage stage), your plan takes over your costs, and you’re essentially done paying for covered drugs for the rest of the year. 

When choosing a Medicare Part D Plan, it’s crucial to consider these three costs. The plan with the lowest premium might not be the least expensive if you pay high copays. 

Meanwhile, a plan with low copays for your drugs might have a higher deductible than your other options with a $0 deductible. Be sure to compare all the numbers before settling on a plan. 

If you’d like help comparing the Medicare Part D Plans available in your area, call or text our team of licensed insurance agents at +1 877-360-6565 (TTY: 771).

4 Ways to Potentially Lower Your Drug Costs with Medicare Part D

If you need expensive prescription drugs, there are several ways to potentially lower your costs with Medicare Part D, such as taking advantage of Medicare’s prescription payment plan, considering mail-in options, enrolling in Medicare’s Extra Help assistance program, or shopping for lower-cost plans. 

#1: Look Into Medicare’s Prescription Payment Plan

If you’re unhappy about the copays on your current Medicare Part D Plan, you may want to consider signing up for Medicare’s prescription payment plan (also known as payment smoothing). Payment smoothing allows you to pay for your drugs in monthly installments rather than a one-time payment. 

For example, if your copay for a drug is $1,000, your $1,000 copay would be divided equally for the remaining months of the year. 

If you opt into a prescription payment plan, you typically wouldn’t pay anything at the pharmacy. Instead, your Medicare Part D Plan would send you monthly bills for your costs. 

Medicare Part D plans are generally required to provide this option. If you’d like to opt in, simply contact your insurance company to find out how to do so. 

#2: Consider Mail-Order Pharmacies

If you’re not in a hurry to get your prescription drugs, you can consider ordering your prescription drugs through a mail-order pharmacy. 

Mail-order pharmacies typically send refills for 90 days, which usually cost less per piece than buying one month’s worth of refills. 

However, mail-order pharmacies are usually not great if you need your medications right away. If you’re unsure how long you’re going to be taking your drugs, 90-day refills may also be more than what you need. 

#3: Look Into Medicare’s Extra Help Program

If you are struggling to pay for your prescription drug costs, Medicare Part D has a program for people with limited income called Extra Help. 

Extra Help can typically help pay for your Medicare Part D premiums, deductibles, copays, and coinsurance. If you have a late enrollment penalty for Medicare Part D, this will be waived if you’re enrolled in Extra Help. 

You’ll typically be enrolled automatically in Extra Help if you have full Medicaid coverage, are enrolled in a Medicare Savings Program, or are taking Supplementary Security Income (SSI) from Social Security. 

If you’re not automatically enrolled, you can enroll in Extra Help if you meet the following criteria for 2026: 

Your situation:	Income limit:	Resource limit:
Individual	$23,940	$18,090
Married couple	$32,460	$36,100

To apply, visit Social Security’s website. 

#4: Shop For Lower-Cost Plans Every Year

Medicare Part D Plans can change their formularies, drug tiers, cost-sharing, network of pharmacies, and other terms every year. That’s why a plan that works great for you this year may cost you a lot more next year. 

Every year, typically around September, Medicare Part D Plans (both PDPs and MAPDs) should send you an Annual Notice of Changes (ANOC) letter. This letter goes over your plan’s upcoming changes for the following year. 

If you’re unhappy with any of the changes, you can shop around and switch to another PDP or MAPD during the Annual Enrollment Period (AEP), which runs from October 15 to December 7 every year. Any plan changes you make during the AEP will take effect on January 1 of the following year. 

Even if you are okay with your plan’s upcoming changes, it’s typically a good idea to still shop your options during the AEP. Doing so may lead you to find another plan that you prefer over your current drug plan. 

Coverage Restriction Rules

If you take more expensive drugs, it’s crucial to check a plan’s coverage restrictions. These are rules that many Medicare Part D Plans have in place, particularly for more expensive medications. Three of the most common coverage restriction rules include prior authorization, step therapy, and quantity limits. 

• Prior authorization is when you and your doctor or healthcare provider must request authorization from your plan before it covers an expensive drug. Medicare Part D Plans often have a set of requirements they ask you to provide before they agree to cover an expensive drug, usually to prove that the drug is medically necessary. 

If your doctor says a drug is medically necessary for you, but you don’t meet your plan’s prior authorization criteria, you can file for an exception. To do this, your doctor should write why they believe that the drug is medically necessary for you, that you will have negative health effects if you use a different drug, and that different drugs won’t be as effective. 

• Step therapy is a type of prior authorization where a Medicare Part D Plan requires you to try a less expensive drug in the same drug category first, before it covers the more expensive drug. If your doctor says the more expensive drug is medically necessary, they can request an exception to step therapy by giving a statement supporting the request. 

This statement should include your doctor’s belief that it’s medically necessary to be on the more expensive drug without trying less expensive drugs first, that you’ll have negative health effects if you take the less expensive drug, and that the less expensive drug will be less effective. 

• Quantity limits come up when Medicare Part D Plans limit the amount of medications you can purchase within a given timeframe (example: only 30 capsules per month). As usual, if your doctor deems it medically necessary for you to take more medication than your plan allows, they can request an exception. 

How to Find the Right Medicare Part D Plan 

To find a Medicare Part D Plan in your area, you can either use Medicare’s Plan Finder Tool or work with a licensed insurance agent. 

How to Find a Medicare Part D Plan By Yourself (DIY Guide)

To find a Medicare Part D Plan on your own, follow these steps: 

1. Go to Medicare’s Plan Finder Tool 

2. Enter your zip code

3. Select the type of plan you’re looking for

• Medicare Advantage Plan (Part C) if you’re looking for an MAPD
• Medicare drug plan (Part D) if you’re looking for a PDP

4. Select which savings programs you’re enrolled in

5. Click on “Yes” when prompted to see your drug costs while you compare plans

• Add all the prescription drugs you are currently taking
• Be sure to include the dosage, package, quantity, and frequency (see your drug packaging or contact your doctor to find these details)

6. Choose up to five pharmacies in your area that you usually use 

• Tip: select “mail-order pharmacy” to see if you can save by mailing your drugs

7. Scroll through your options, take note of the:

• Monthly premium
• Total drug & premium cost for the rest of the year
• Deductible

8. Click on “plan details” to see how each plan covers your prescription drugs

9. On the previous page, tick “Add to Compare” for several plans to see how they stack up against each other.

How to Find a Medicare Part D Plan Through a Licensed Insurance Agent

If you don’t want to go through the hassle of finding a plan on your own, you can contact a licensed insurance agent for help at no cost to you. 

Licensed insurance agents use advanced tools that easily allow them to find the plans within your budget. You simply tell them your prescription drugs, and they’ll typically show you many lower-cost options. 

If you’re thinking of getting a Medicare Advantage Prescription Drug Plan, licensed insurance agents can also help you compare which healthcare plan may be the best for you. With a MAPD, you can’t separate the healthcare coverage and the prescription drug plan, so finding which MAPD works best for all your needs can sometimes be tricky. 

With the help of a licensed insurance agent, you’ll have a hassle-free experience finding the best plan fit for you. 

So call or text our team of licensed insurance agents today at +1 877-360-6565 (TTY: 711), or click the button below to get in touch. 

Medicare Part D Frequently Asked Questions (FAQs)

How often should I review my Part D coverage? 

You should typically review your Medicare Part D coverage every year around September. Your plan should send you an Annual Notice of Changes (ANOC) letter that goes over your plan’s upcoming changes for the next year. 

You can switch to a new plan or drop your current plan during the Annual Enrollment Period, which runs from October 15 to December 7 every year. 

What’s the difference between generic and brand-name coverage?

Generic drugs typically cost less than brand-name drugs. These two have the same active ingredient, strength, dosage form, route of administration, and therapeutic effect. However, they may contain different inactive ingredients such as fillers and dyes. 

In some cases, your Medicare Part D Plan may require you to take a generic drug before it covers the more expensive brand-name counterpart (step therapy). 

What happens if my medication is removed from my plan’s formulary mid-year?

Medicare Part D Plans are not allowed to completely remove a prescription drug from their formulary unless clinical guidelines or the Food and Drug Administration (FDA) raise safety concerns. 

However, during the year, Medicare Part D Plans are typically allowed to: 

• Replace coverage for a brand-name drug with its generic counterpart
• Change the tier of a brand-name drug after introducing a generic counterpart
• Add coverage restrictions to a drug
• Remove drugs that were unintentionally included in the formulary

If your plan makes these changes, they are required to notify you 60 days in advance, as well as provide you with a 60-day transition refill. 

If your doctor says it’s medically necessary for you to continue using a brand-name drug that’s replaced by its generic counterpart, you can file for an exception. 

Can I have both a Medicare Advantage plan and a standalone Part D plan? 

Yes, but only if your Medicare Advantage Plan does not have a built-in prescription drug coverage. You cannot have both a MAPD and a PDP at the same time. 

How do star ratings affect my coverage quality? 

Star ratings are the CMS’s (Centers for Medicare and Medicaid Services) way of grading the quality of service of Medicare Part D Plans (both MAPD and PDP). 

The CMS rates these plans from one to five stars, with five stars being the highest quality. 

Before enrolling in a plan, checking its star rating can give you an idea of how reliable other people believe the plan is. 

What happens if I don’t enroll in Part D when first eligible? 

If you don’t enroll in a Medicare Part D Plan during your Initial Enrollment Period (IEP), and you don’t have creditable coverage from elsewhere, you’ll be subject to a permanent late enrollment penalty for Medicare Part D. 

The late enrollment penalty is an extra 1% of the Part D national base premium for every month that you delay. If you delay for 12 months, you’ll typically have to pay 12% of the national base premium every month for as long as you have a Medicare Part D Plan. 

In 2025, the Part D national base premium is set to $38.99.

Note: “creditable coverage” refers to prescription drug coverage that’s “equal to or better than” Medicare Part D. You may contact your insurance company to find out if your current drug coverage is considered creditable by Medicare. 

How does Part D work with other prescription coverage I might have? 

It depends. Some non-Medicare prescription drug plans can coordinate benefits with your Medicare Part D Plan, while others may not.

Contact your plan to find out whether it makes sense to keep your drug coverage alongside Medicare Part D. 

Should I choose Medicare Advantage or a standalone Part D plan? 

Generally speaking, people who prefer Medicare Supplement Plans tend to enroll in a standalone Medicare Part D Prescription Drug Plan (PDP), while people who prefer Medicare Advantage usually use the built-in prescription drug plan there. 

If you’d like to learn more about the differences between Medicare Supplement and Medicare Advantage, check out this video: 

Finding The Right Prescription Drug Plan For YOU

Medicare Part D is arguably the most confusing part of Medicare. 

However, now that you know what to look for, how to reduce your costs, and how to find plans available in your area, you should be able to land on the right prescription drug plan for you. 

Make sure to thoroughly review all your options, because you can miss out on big savings if you just take the first plan you see.

If you’d like the professionals to do the number crunching for you instead, don’t hesitate to reach out to our team of licensed insurance agents at +1 877-360-6565 (TTY: 711), or click the button below to get in touch.