Medicare Part D

Two Paths to Drug Coverage: What Changes When You Switch

TUSCALOOSA, Ala. — If you take even one prescription regularly, the way you get Medicare drug coverage matters. Heading into 2027, Tuscaloosa residents on Medicare still face the same basic choice they always have: pair Original Medicare with a stand-alone Part D drug plan, or pick a Medicare Advantage plan that folds drug coverage inside. Both routes end at the same place — coverage for your medicines — but they are built differently, and moving between them can change more than your pharmacy bill.

Two structures, one goal

A stand-alone Part D plan is a drug-only policy you add on top of Original Medicare (Parts A and B). Your medical care runs through Original Medicare — any doctor or hospital that accepts Medicare — and your prescriptions run through the separate Part D plan.

A Medicare Advantage plan with drug coverage (often called an MA-PD) is a single plan from a private insurer that replaces the way Original Medicare pays your claims. Your hospital, doctor visits, and drugs are all handled under one plan, usually with a network of providers.

Tuscaloosa is in Tuscaloosa County, where both types of coverage are sold by multiple carriers. The choice isn't about which one is "better" in general — it's about which structure fits your health, your doctors, and your budget.

What stays the same in 2027

No matter which path you pick, the core Part D rules apply:

• The out-of-pocket cap for covered drugs is $2,100 in 2026 and rises to $2,400 in 2027. Once you hit it, you pay nothing for covered prescriptions the rest of that calendar year.
• The maximum deductible a plan can charge for drugs is $615.
• The old "donut hole" coverage gap is gone as of 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly payments instead of paying a big bill at the pharmacy counter.
• Higher-income beneficiaries pay an IRMAA surcharge on Part D premiums; for a single filer in 2026, that begins above $109,000 in income.

These rules don't change based on whether your drug coverage is stand-alone or built into an Advantage plan.

What changes when you switch

Moving between the two paths affects more than the drug side of the equation.

Going from Original Medicare + Part D to Medicare Advantage. You'll likely move into a provider network, and referrals or prior authorization may apply for specialists. If you had a Medigap (Medicare Supplement) policy, you generally drop it when joining Advantage — and getting it back later isn't guaranteed at the same price or without medical underwriting in most states, Alabama included.

Going from Medicare Advantage to Original Medicare + Part D. You get the broad any-Medicare-provider access of Original Medicare, but you lose the built-in out-of-pocket limit on medical care that Advantage plans include. Many people add a Medigap policy to fill that gap, and outside a guaranteed-issue window, you may face health questions when applying.

In both directions, your drug formulary — the list of covered medicines — will likely change, along with preferred pharmacies and cost tiers. Before switching, check whether your regular prescriptions are covered and how.

When you can make the move

Two windows matter most:

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can join, drop, or switch Part D and Medicare Advantage plans. Changes take effect Jan. 1.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you can switch to a different one or drop back to Original Medicare (and add a Part D plan). You can't use this window to go from Original Medicare into Advantage.

Special Enrollment Periods may also apply if you move, lose other coverage, or qualify for Extra Help.

How to think about the decision

Start with three questions:

1. Who are your doctors, and how do they bill Medicare? If you value seeing any provider that takes Medicare with no referral, Original Medicare plus Part D leans your way. If you're comfortable with a network and like one-plan simplicity, Advantage may fit. 2. What medicines do you take? Pull your list and check each plan's formulary. The same drug can sit on different tiers under different plans. 3. How would you cover the medical side? With Original Medicare, most people add Medigap for predictable costs. With Advantage, that's built in — but the trade-off is the network and plan rules.

For personalized help in Tuscaloosa, the Alabama SHIP (State Health Insurance Assistance Program) offers free, unbiased counseling.