Medicare Part D
Two Drug Coverage Paths, One $2,100 Cap: Know the Difference
In New Castle, people turning 65 or already on Medicare face a choice that trips up a lot of families: how to get help paying for prescriptions. Medicare offers two very different paths to drug coverage, and the one you pick shapes the rest of your Medicare setup. Understanding how each structure works — and what shifts if you move from one to the other — can save you a lot of confusion later.
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Key takeaways
- Drug coverage comes either as a stand-alone Part D plan paired with Original Medicare or built into a Medicare Advantage plan; the two paths cannot be mixed.
- Part D has an annual out-of-pocket cap on covered drugs and a maximum deductible set by Medicare, no matter which path you take: $2,100 and $615 in 2026, and $2,400 and $700 in 2027.
- Switching between the two usually happens during the Annual Enrollment Period, Oct. 15 – Dec. 7, or the Medicare Advantage Open Enrollment Period, Jan. 1 – March 31.
- New Castle is in New Castle County, where multiple stand-alone Part D plans and Medicare Advantage plans with drug coverage are offered each year.
The two paths, side by side
The first path is Original Medicare (Parts A and B) plus a stand-alone Part D plan. Part A and Part B come from the federal government and cover hospital and medical care. Part D is a separate prescription drug plan you buy from a private insurer that Medicare has approved. Many people on this path also add a Medigap (supplement) policy to help with Part A and Part B out-of-pocket costs.
The second path is a Medicare Advantage plan that includes drug coverage — often called an MA-PD. These plans are offered by private insurers approved by Medicare. They bundle Part A, Part B, and Part D into one plan, and often add extras like dental or vision. You still have Medicare, but the plan handles your benefits.
You cannot mix and match. If you join a Medicare Advantage plan that already includes drugs, you generally cannot also enroll in a stand-alone Part D plan. Doing so can actually get you dropped from your Advantage plan.
What actually changes when you switch
Moving between the two paths is bigger than just changing a drug plan. Here is what tends to shift:
- Your doctor and hospital access. Original Medicare lets you see any provider in the U.S. that accepts Medicare. Medicare Advantage plans typically use networks (HMO or PPO), so your doctors may or may not be in-network.
- How you pay. With Original Medicare plus Part D, you have separate premiums and cost-sharing for Part B, Part D, and any Medigap policy. With Medicare Advantage, most of your costs run through the one plan, which also has a yearly out-of-pocket maximum for medical care.
- Referrals and prior authorization. Original Medicare rarely requires either. Advantage plans often do.
- Medigap eligibility. This one surprises people. If you drop Medicare Advantage to return to Original Medicare, you may not automatically qualify for a Medigap policy at your original rate. Insurers can use medical underwriting in most states, which means they can charge more or deny coverage based on your health. Talk with Delaware's SHIP before making the jump.
The Part D rules that apply either way
No matter which path you pick, some Part D rules are set by Medicare itself:
- An out-of-pocket cap on covered prescription drugs: $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing more for covered drugs that year.
- A maximum deductible of $615 in 2026 and $700 in 2027, though plans can set theirs lower.
- No more donut hole. The coverage gap was eliminated in 2025, so Part D now has three phases instead of four.
- The Medicare Prescription Payment Plan, an optional program that lets you spread your drug costs across the year in monthly payments instead of paying big amounts at the pharmacy counter.
Higher earners should also know about IRMAA — an income-related surcharge added to Part B and Part D premiums. In 2026, it starts above $109,000 in income for a single filer, based on tax returns from two years earlier.
When you can move between the two
New Castle residents have two main windows each year:
- Annual Enrollment Period (Oct. 15 – Dec. 7): Open to everyone on Medicare. You can switch between Original Medicare and Medicare Advantage, join or change a Part D plan, or drop drug coverage. Changes take effect Jan. 1.
- Medicare Advantage Open Enrollment (Jan. 1 – March 31): If you're already in a Medicare Advantage plan, you can switch to a different Advantage plan or drop back to Original Medicare and pick up a stand-alone Part D plan.
Certain life events — moving, losing other coverage, qualifying for Extra Help — can open a Special Enrollment Period outside these windows.
The local picture
New Castle is in New Castle County, where both stand-alone Part D plans and Medicare Advantage plans with drug coverage are available to residents. Plan lineups change every year, so even if you're happy today, it's worth a look each fall. The Medicare Plan Finder at medicare.gov lets you enter your ZIP code and your prescriptions to see how the available plans handle your specific drug list.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in New Castle County
(MA penetration in New Castle County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Can I have both a Medicare Advantage plan and a stand-alone Part D plan?
If I switch from Medicare Advantage back to Original Medicare, can I still get a Medigap policy?
Does the $2,100 out-of-pocket cap apply to both paths?
When can I change my drug coverage?
- CMS — Medicare Part D program rules (medicare.gov)
- CMS — Medicare basics (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Also for New Castle
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This page was last updated: October 6, 2026.