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Prescription drug costs are a top concern for Florida seniors, and Medicare Part D is the primary vehicle for managing them. Part D has been a part of Medicare since 2006, but the program underwent its most significant reforms in decades with the passage of the Inflation Reduction Act — changes that took effect in 2025 and continue to expand through 2026. Understanding how Part D works, how to choose the right plan, and whether you qualify for financial assistance can save you thousands of dollars per year.
Medicare Part D is voluntary prescription drug coverage offered through private insurance companies that contract with Medicare. Part D is NOT automatically included in Original Medicare (Parts A and B) — you must actively enroll in a standalone Part D Prescription Drug Plan (PDP) or choose a Medicare Advantage plan that includes drug coverage (MA-PD).
Part D covers most FDA-approved prescription drugs, including brand-name and generic medications. However, each plan maintains its own formulary — the list of covered drugs — and the specifics vary significantly from plan to plan. Some drug categories are excluded from Part D by law, including drugs used for weight loss, fertility, or cosmetic purposes. Benzodiazepines and barbiturates were historically excluded but are now covered under most plans.
Part D plans organize covered drugs into tiers, with each tier carrying different cost-sharing requirements. While specific amounts vary by plan, the general structure is consistent across most Florida Part D plans:
| Tier | Drug Type | Typical Cost Sharing | Examples |
|---|---|---|---|
| Tier 1 | Preferred generic drugs | $0–$5 copay | Metformin, lisinopril, atorvastatin |
| Tier 2 | Non-preferred generic drugs | $10–$20 copay | Generic drugs not on preferred list |
| Tier 3 | Preferred brand-name drugs | $40–$50 copay | Eliquis, Xarelto, Jardiance |
| Tier 4 | Non-preferred brand-name drugs | 40–50% coinsurance | Brand drugs without preferred status |
| Tier 5 | Specialty drugs | 25–33% coinsurance | Biologic drugs, cancer medications, MS drugs |
The Inflation Reduction Act fundamentally restructured Medicare Part D beginning in 2025. The most impactful changes for Florida beneficiaries include:
For the first time in Medicare history, Part D now has a hard annual out-of-pocket cap. Once you have spent $2,000 in covered drug costs in a calendar year, your plan pays 100% for the remainder of the year. This is a massive benefit for beneficiaries who take expensive specialty medications — previously there was no cap in the catastrophic phase, and some patients faced tens of thousands of dollars in annual drug costs.
The old Part D "coverage gap" (the donut hole) and separate catastrophic phase have been replaced by a streamlined two-phase structure: the deductible phase and the coverage phase. Once you've met your deductible, you pay standard cost sharing until you hit the $2,000 cap.
Under the IRA, Medicare gained the authority to directly negotiate drug prices with pharmaceutical manufacturers. The first 10 negotiated drugs took effect in 2026. These include Eliquis, Jardiance, Xarelto, Januvia, and several others commonly prescribed to Florida Medicare beneficiaries. Negotiated prices apply at the pharmacy counter for Part D enrollees.
Starting in 2025, beneficiaries can opt into a monthly payment program that spreads their out-of-pocket drug costs evenly across the calendar year rather than paying large lump sums at the pharmacy. This is voluntary and available through participating Part D plans.
Extra Help (formally called the Low Income Subsidy, or LIS) is a federal assistance program that helps Medicare beneficiaries with limited incomes pay for Part D costs. Qualifying for Extra Help can virtually eliminate your Part D premium and dramatically reduce your drug copays.
Floridians who qualify for Medicaid or receive Supplemental Security Income (SSI) are automatically enrolled in Extra Help. If you are not automatically enrolled but think you might qualify, apply — Social Security will determine your eligibility at no cost to you. If you qualify for Extra Help, you also have a continuous monthly SEP to switch Part D plans, giving you more flexibility than other beneficiaries.
If you do not enroll in a Part D plan (or maintain other creditable prescription drug coverage, such as through an employer) when you are first eligible for Medicare, and then go 63 or more consecutive days without that coverage, you will owe a late enrollment penalty. The penalty equals 1% of the national base beneficiary premium for each full month you went without coverage, and it is added permanently to your monthly Part D premium.
For 2026, the national base beneficiary premium is approximately $36.78/month. A 24-month gap would result in a permanent penalty of roughly $8.83/month added to whatever premium your plan charges. This penalty persists for as long as you have Part D coverage.
The Medicare Plan Finder tool at medicare.gov/plan-compare is the best starting point for comparing Part D plans in your specific Florida zip code. To use it effectively:
In Florida, some of the most widely available standalone Part D plans come from Humana, UnitedHealthcare, CVS Health/Silverscript, Cigna, and WellCare. Premiums and formularies vary by county, so a plan that is optimal in Miami-Dade may not be the best choice in Escambia County.
The majority of Medicare Advantage plans sold in Florida include prescription drug coverage — these are called MA-PD plans. If you are enrolled in an MA-PD plan, you do not need and cannot enroll in a separate standalone Part D plan. Your MA-PD plan's formulary, tiers, and cost sharing apply for your prescription drugs.
When comparing MA-PD plans, pay close attention to the Part D component — especially if you take specialty or brand-name medications. An MA-PD plan with a low monthly premium may charge you significantly more for your specific drugs than a plan with a slightly higher premium but a more favorable formulary placement for those medications.
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What is the Medicare Part D out-of-pocket cap in 2026?
As of 2025, the Inflation Reduction Act established a $2,000 annual out-of-pocket cap for Medicare Part D prescription drug costs. Once you have paid $2,000 in covered drug costs in a calendar year, your Part D plan covers 100% of the cost for the rest of the year. This cap applies to all standalone Part D plans and Medicare Advantage plans with Part D coverage.
What is a formulary in Medicare Part D?
A formulary is the list of drugs covered by a specific Part D plan. Drugs on the formulary are grouped into tiers, with lower tiers generally costing less. If your medication is not on the plan's formulary, you may have to pay full cost or request an exception. Formularies can change each year, so it is important to review your plan during the Annual Enrollment Period.
What is the Medicare Part D late enrollment penalty?
If you go 63 or more consecutive days without creditable prescription drug coverage after your Initial Enrollment Period ends, you will owe a Part D late enrollment penalty. The penalty is 1% of the national base beneficiary premium for each month without coverage, and it is added permanently to your monthly Part D premium.
What is Extra Help for Medicare Part D?
Extra Help, also called the Low Income Subsidy (LIS), is a federal program that helps people with limited income and resources pay for Medicare Part D costs including premiums, deductibles, and copays. In 2026, you may qualify for Extra Help if your annual income is below roughly 150% of the federal poverty level. Floridians can apply through Social Security or the Florida Department of Children and Families.
Can I have Medicare Advantage and Part D at the same time?
Most Medicare Advantage plans already include Part D prescription drug coverage — these are called MA-PD plans. If your Medicare Advantage plan includes drug coverage, you cannot also enroll in a separate standalone Part D plan. If your MA plan does not include drug coverage, you can enroll in a standalone Part D plan alongside it.