Florida Medicare Part D Prescription Drug Plans — How to Compare 2026

By the Florida Plan Finder Team · Licensed Florida Health Insurance Producer · NPN #21249133 · Last Updated: May 4, 2026

Key Takeaways

Medicare Part D covers outpatient prescription drugs through standalone PDPs or Medicare Advantage drug plans (MA-PD).
The Inflation Reduction Act capped Part D out-of-pocket costs at $2,000 in 2026 — a landmark protection for high-cost drug users.
Insulin is capped at $35/month per covered insulin for all Part D enrollees (no deductible applies to insulin).
The Part D late enrollment penalty is permanent: 1% per month uncovered — a lifelong surcharge on your premium.
Low-income beneficiaries may qualify for Extra Help (LIS), which dramatically reduces Part D costs.
Always run your specific drug list through Medicare.gov's Plan Finder — formularies vary significantly between plans.

Prescription drug costs are one of the biggest financial concerns for Medicare beneficiaries. Without coverage, the price of brand-name specialty drugs can run thousands of dollars per month. Medicare Part D was created to provide affordable drug coverage, and it has been significantly strengthened by the Inflation Reduction Act — most notably with a $2,000 annual out-of-pocket cap that took effect in 2025 and remains in place for 2026.

This guide explains how Part D works, how to read a formulary, how the late enrollment penalty accumulates, what Extra Help can do for you, and how to use Medicare's Plan Finder tool to identify the lowest-cost plan for your specific drug list in Florida.

Jump to Section

Standalone PDP vs MA-PD Plans
Formulary Tiers Explained
2026 Part D Cost Structure
Inflation Reduction Act Changes
Late Enrollment Penalty
Extra Help / Low Income Subsidy
How to Compare Plans
Frequently Asked Questions

Standalone PDP vs MA-PD Plans

There are two ways to get Part D drug coverage: through a standalone Prescription Drug Plan (PDP) paired with Original Medicare, or through a Medicare Advantage Prescription Drug (MA-PD) plan that bundles medical and drug coverage together.

Feature	Standalone PDP	MA-PD (Medicare Advantage)
Works with	Original Medicare (+ optional Medigap)	Medicare Advantage plan only
Medical coverage	Original Medicare pays (Parts A & B)	MA plan pays medical benefits
Enrollment	Separate enrollment from medical coverage	Single enrollment covers both
Can you combine PDP + MA?	No — you cannot enroll in a standalone PDP if you're in an MA-PD plan
Best strategy	Original Medicare + Medigap + PDP for drug coverage	MA-PD for all-in-one coverage

If you choose an MA plan with no drug coverage (called MAPD-without-drugs, now rare), you may be able to add a PDP in some circumstances — but most plans today bundle drugs. Confirm your plan's drug coverage status when enrolling.

Comparing Medicare plans in Florida

(877) 417-2421

Formulary Tiers Explained

Every Part D plan has a formulary — a list of covered medications organized into tiers. Your cost (copay or coinsurance) depends on which tier your drug is on. The standard tier structure in 2026:

Tier	Drug Type	Typical Cost (after deductible)
Tier 1	Preferred generic drugs	$0–$5 copay
Tier 2	Non-preferred generic drugs	$10–$15 copay
Tier 3	Preferred brand-name drugs	$35–$47 copay
Tier 4	Non-preferred brand-name drugs	$85–$100 copay or 40–50% coinsurance
Tier 5	Specialty drugs (high-cost biologics, etc.)	25–33% coinsurance (subject to $2,000 annual cap)

Formularies vary by plan — a drug that's Tier 2 on one plan may be Tier 4 on another. Some plans also use "preferred pharmacy" networks where you pay lower copays at certain chain pharmacies (CVS, Walgreens, Walmart, etc.) versus non-preferred pharmacies. Always check your specific medications and preferred pharmacy when comparing plans.

Generic substitutions save money: If your doctor prescribes a brand-name drug with a generic equivalent, ask whether the generic is therapeutically interchangeable. Switching from Tier 3 to Tier 1 can save hundreds of dollars per year in drug costs.

2026 Part D Cost Structure

Part D costs flow through several phases in a calendar year. Understanding the structure helps you anticipate your spending and plan accordingly.

Phase	You Pay	2026 Threshold
Deductible	100% of drug costs up to the deductible	Up to $590/year (plan may waive for Tier 1-2)
Initial coverage	Copays/coinsurance per formulary tier	Until you reach $2,000 TrOOP
Catastrophic / cap	$0 for covered drugs	After $2,000 out-of-pocket (True Out-of-Pocket)

The True Out-of-Pocket (TrOOP) threshold counts only what you personally pay — your deductible payments and your share of drug costs. Manufacturer discounts on brand-name drugs count toward TrOOP, which can help you reach the cap faster on expensive medications.

Inflation Reduction Act Changes in 2026

The Inflation Reduction Act (IRA) of 2022 made sweeping changes to Part D that are fully in effect for 2026. The most significant improvements for Florida Medicare beneficiaries:

$2,000 annual out-of-pocket cap: No more unlimited catastrophic-phase spending. Once you've paid $2,000 in out-of-pocket drug costs in a calendar year, your copays drop to $0 for the rest of the year for covered drugs.
$35 insulin cap: Covered insulin products are capped at $35/month per insulin per covered Part D plan — regardless of which phase you're in and regardless of the deductible. You never pay more than $35 for a covered insulin per month.
Smoothed cost-sharing (Medicare Prescription Payment Plan): Beneficiaries can spread their Part D out-of-pocket costs across monthly payments throughout the year instead of facing large upfront bills early in the year.
Enhanced Extra Help: More beneficiaries qualify for LIS/Extra Help under expanded income limits.

Insulin users: $35 cap applies now. If you use insulin and are enrolled in any Part D plan, your monthly cost per covered insulin is capped at $35 — even if you haven't met your deductible yet. If your plan is charging you more, contact your plan or call 1-800-MEDICARE.

The Part D Late Enrollment Penalty

The Part D late enrollment penalty is one of the most misunderstood — and punishing — aspects of Medicare. Here's what you need to know:

If you go 63 or more consecutive days without creditable prescription drug coverage after your first chance to enroll in Part D, you'll owe a permanent monthly surcharge on any Part D plan you eventually join. The penalty is calculated as:

Penalty = 1% × National Base Beneficiary Premium × Number of uncovered months

In 2026, the national base beneficiary premium is $36.78. A 24-month gap without drug coverage would result in a permanent $8.83/month surcharge (24% × $36.78). This penalty stays with you for life — it doesn't go away after you pay it for a certain number of years.

Employer drug coverage must be "creditable": Coverage from an employer, union, VA, or TRICARE may count as creditable drug coverage — meaning it's at least as good as Medicare Part D. Your employer must provide a notice each year telling you whether your coverage is creditable. Keep this notice. If you lose creditable coverage, you have a 63-day Special Enrollment Period to join Part D without penalty.

Extra Help / Low Income Subsidy (LIS)

Extra Help is a federal program (also called the Low Income Subsidy or LIS) that helps people with limited income and resources pay Part D costs. In 2026, the income limit for full Extra Help is approximately 135% of the Federal Poverty Level (about $20,000 for an individual, $27,000 for a couple). A partial subsidy extends to about 150% FPL.

With full Extra Help in 2026, your Part D benefits include:

$0 Part D premium (you're automatically enrolled in a low-premium benchmark plan)
$0 deductible for Part D
Copays capped at $4.50 for generic/preferred drugs and $11.20 for brand-name drugs
$0 after reaching the catastrophic phase

You can apply for Extra Help through Social Security (online at ssa.gov, by calling 1-800-772-1213, or in person at a Florida Social Security office), or through your local State Health Insurance Assistance Program (SHIP). If you qualify for Medicaid or a Medicare Savings Program, you're automatically eligible for Extra Help.

How to Compare Part D Plans in Florida

The best way to find the lowest-cost Part D plan for your specific medications is to use Medicare's official Plan Finder tool at medicare.gov/plan-compare. Here's the step-by-step process:

Step 1: Go to medicare.gov/plan-compare and enter your ZIP code.
Step 2: Select "Drug plans (Part D)" for standalone coverage, or "Medicare Advantage plans with drug coverage" for MA-PD plans.
Step 3: Add all your current medications by name and dosage. Include the quantities and dosing frequency.
Step 4: Enter your preferred pharmacy (chain or independent).
Step 5: Review the results sorted by "Estimated Annual Drug + Premium Cost" — this is the most accurate total-cost comparison.
Step 6: Click through to each plan's formulary detail to confirm tier placement and any restrictions (prior authorization, step therapy, quantity limits).

Review Part D plans every AEP: Formularies change every January 1. A drug that was Tier 2 this year may move to Tier 4 next year. Review your coverage every Annual Enrollment Period (October 15–December 7) to make sure your current plan is still the best fit for your medications.

Florida Part D Carriers (Standalone PDPs)

Florida beneficiaries on Original Medicare can choose from among the following major standalone PDP carriers in 2026. Premiums and formularies vary by plan name and Florida county:

Carrier / Plan Family	Notable Plans	Approximate Monthly Premium Range (FL)
Humana	Humana Value Rx, Humana Premier Rx	$11–$80/month
UnitedHealthcare (AARP)	AARP MedicareRx Preferred, AARP MedicareRx Saver Plus	$34–$110/month
Cigna	Cigna Healthcare Rx Secure, Extra	$21–$65/month
Wellcare (Centene)	Wellcare Value Script, Classic	$0–$35/month
SilverScript (CVS/Aetna)	SilverScript Choice, Plus	$9–$62/month

Premium alone is not the right comparison metric — a $0-premium plan may have a high deductible and unfavorable tier placement for your specific drugs. Always compare total estimated annual cost (premium + deductible + drug costs) using your actual medication list. For help comparing Part D plans or Medicare Advantage drug coverage, contact FloridaPlanFinder.com at . For Florida health insurance resources beyond Medicare, see floridaplanfinder.com and floridaplanfinder.com.

Talk to a Licensed Florida Medicare Agent — Free

Get personalized Medicare guidance from a licensed Florida agent. Compare plans, check your doctors, and enroll — at no cost to you.

Get My Free Plan Comparison

Frequently Asked Questions

What is the Part D out-of-pocket cap in 2026?

Thanks to the Inflation Reduction Act, the Part D out-of-pocket cap is $2,000 in 2026. Once you've spent $2,000 on covered drugs (after the deductible), you pay $0 for the rest of the calendar year. This eliminates the financial exposure that existed in the old catastrophic phase structure. The cap applies to all Part D plans.

How do I know if my medications are covered by a Part D plan?

Every Part D plan has a formulary — a list of covered drugs — organized into tiers. You can check a plan's formulary using the Medicare Plan Finder tool at medicare.gov or by calling the plan directly. Enter your specific medications and pharmacy to get an accurate cost estimate. A licensed agent can also run this comparison for you across multiple plans simultaneously.

What is the Part D late enrollment penalty?

If you go 63 or more consecutive days without creditable prescription drug coverage after your initial Medicare enrollment window, you'll owe a permanent late enrollment penalty. The penalty is 1% of the national base beneficiary premium ($36.78 in 2026) for each month you were uncovered. Going 24 months without Part D coverage adds a permanent 24% surcharge — about $8.83/month in 2026 — to your future Part D premiums for life.

What is Extra Help (Low Income Subsidy) for Part D?

Extra Help, also called the Low Income Subsidy (LIS), is a federal program that helps people with limited income and resources pay Part D premiums, deductibles, and copays. Individuals with income below approximately 150% of the federal poverty level may qualify. Extra Help can reduce or eliminate the Part D deductible and cap drug copays at very low amounts ($4.50 for generics, $11.20 for brand-name in 2026 at the full subsidy level). Apply through Social Security or your local SHIP office.

Should I get a standalone PDP or a Medicare Advantage plan with drug coverage?

If you choose Original Medicare with a Medigap plan, you'll need a standalone Part D PDP for drug coverage. If you choose a Medicare Advantage plan, most MA plans include drug coverage (called MA-PD plans) and you generally cannot add a standalone PDP. The best choice depends on your overall coverage strategy: if you want Original Medicare's freedom and Medigap's cost protection, add a PDP. If you're in MA, compare the drug formulary of each MA-PD plan alongside its medical benefits.

Licensed Florida Health Insurance Producer · NPN #21249133Information on this page is for general reference and is updated regularly. Verify current plan availability and costs at HealthCare.gov before enrolling.