Medicare Part D

Does your drug coverage sit inside or beside Medicare?

PLANTATION, Fla. — If you live here and take even one prescription, you have likely bumped into a basic Medicare question: should your drug coverage come as a stand-alone Part D plan paired with Original Medicare, or should it be built into a Medicare Advantage plan? Both roads lead to drug coverage, but the structure around that coverage looks different, and so does what happens when you move from one to the other.

This is not a question of which path is "better." It is a question of how each one is put together, and what changes if you switch. Plantation is in Broward County, where Medicare plan availability is set at the county level, so your choices on both sides are shaped by what is offered countywide.

The two structures, side by side

A stand-alone Part D plan is a drug-only plan. You use it with Original Medicare (Part A and Part B), and if you want help with hospital and doctor cost-sharing, you may also carry a Medigap (Medicare Supplement) policy. In this setup, three separate pieces work together: Original Medicare for medical care, Medigap for cost-sharing, and Part D for prescriptions.

A Medicare Advantage plan with drug coverage, sometimes called an MAPD, folds medical and drug benefits into one plan from a private insurer. Instead of three cards, you generally use one plan for both doctor visits and the pharmacy counter. Medicare Advantage plans often use provider networks and may require referrals or prior authorizations, depending on how the plan is designed.

What stays the same no matter which path you choose

Part D rules set by Medicare apply to both structures. The key 2027 figures:

• An out-of-pocket cap on what you pay for covered Part D drugs in a calendar year of $2,100 in 2026 and $2,400 in 2027.
• A maximum deductible of $615 in 2026 and $700 in 2027 (plans can set a lower one).
• Three coverage phases instead of the old "donut hole," which was eliminated starting in 2025.
• The option to use the Medicare Prescription Payment Plan, which lets you spread your drug costs across the year in monthly payments instead of paying large amounts at the pharmacy.
• Income-related surcharges (IRMAA) that can apply to higher earners — in 2026, these begin above $109,000 in income for a single filer.

Those program-level rules follow you whether your drug coverage sits inside Medicare Advantage or in a stand-alone plan.

What changes if you move between paths

Switching is where people get surprised, so it helps to know the moving parts.

Moving from Original Medicare + stand-alone Part D into a Medicare Advantage plan with drug coverage. You generally cannot keep a stand-alone Part D plan at the same time as an MAPD; enrolling in the Advantage drug plan usually ends the stand-alone one. Your medical coverage shifts from Original Medicare's any-provider structure to the Advantage plan's network. If you had a Medigap policy, you will not need it while you are on Advantage — but dropping Medigap can have long-term consequences, since in most situations outside your initial Medigap enrollment window, insurers can use medical underwriting if you later want to buy a policy back.

Moving from Medicare Advantage back to Original Medicare plus a stand-alone Part D plan. You return to Medicare's traditional structure, and you pick up a separate drug plan. You may also want to add Medigap, but again, outside of guaranteed-issue situations, acceptance and pricing can depend on your health history. Florida has its own Medigap rules; your local SHIP counselor can walk you through them.

When you can actually make a change

Two windows do most of the work:

• Annual Enrollment Period (October 15 – December 7): You can join, switch or drop Medicare Advantage and Part D plans. Changes take effect January 1.
• Medicare Advantage Open Enrollment Period (January 1 – March 31): If you are already in an Advantage plan, you can switch to another Advantage plan or go back to Original Medicare and add a stand-alone Part D plan. You cannot use this window to move from Original Medicare into Advantage.

Special Enrollment Periods may also apply for life events such as a move, loss of other coverage, or qualifying for Extra Help.

A few things worth checking before you switch

• Is your pharmacy in the plan's network, and is it a "preferred" one?
• Are your prescriptions on the plan's formulary, and at what tier?
• If you are considering Medicare Advantage, are your doctors and preferred hospitals in network?
• If you are considering leaving Advantage, how will Medigap underwriting work for you in Florida?

Star Ratings, published by Medicare, can give you a general sense of plan quality. They are a tool for comparison, not a scorecard for picking a winner.