Medicare Part D

Two Ways to Get Medicare Drug Coverage in Elmhurst

ELMHURST, Ill. — If you take even one prescription regularly, the way you get your Medicare drug coverage matters. In and around Elmhurst, most people end up in one of two setups: Original Medicare paired with a stand-alone Part D drug plan, or a Medicare Advantage plan that folds drug coverage in with everything else. Both are legal, both are common, and both follow the same federal rules on drug costs — but the day-to-day experience is different, and switching between them changes more than just your pharmacy card.

The two structures, side by side

With Original Medicare plus a stand-alone Part D plan, you have three cards in your wallet: your red-white-and-blue Medicare card for hospital (Part A) and doctor (Part B) services, and a separate card from a private Part D drug plan. You can also add a Medigap (Medicare Supplement) policy to help with Part A and B out-of-pocket costs.

With a Medicare Advantage plan that includes drug coverage (often called an MA-PD), a private plan handles your Part A, Part B, and Part D benefits together. You typically get one card and one set of rules. Most Advantage plans in Illinois use provider networks and may require referrals or prior authorization for certain services and medications.

What stays the same either way

The core Part D rules apply no matter which route you pick. Key 2027 figures:

• The annual out-of-pocket cap on covered prescriptions is $2,400 in 2027, up from $2,100 in 2026.
• The Part D deductible cannot exceed $700 in 2027, up from $615 in 2026.
• The old "donut hole" coverage gap is gone as of 2025, replaced with a simpler three-phase design.
• You can ask to spread your drug costs across the year through the Medicare Prescription Payment Plan, which is optional and free to enroll in.
• Higher-income enrollees pay an IRMAA surcharge on Part D; for a single filer in 2026, that starts above $109,000 in income.

Each plan still has its own formulary (the list of covered drugs), preferred pharmacies, and tier structure, so two plans that both follow those federal rules can still cover your medications very differently.

What changes when you switch

Moving between the two structures is more than a paperwork change. A few things to think about:

Networks and doctors. Original Medicare is accepted by most providers nationwide. Medicare Advantage plans generally use local networks. If you leave an Advantage plan, you'll want to confirm your doctors accept Original Medicare (most do) and check whether specialists you use are still reachable without referrals.

Medigap timing. This one catches people off guard. You have guaranteed rights to buy a Medigap policy when you first sign up for Part B. If you later drop an Advantage plan and want to add Medigap, insurers in Illinois can, in most cases, use medical underwriting — meaning your health history can affect whether you're approved or what you pay. There are a few exceptions, including a "trial right" if you're within your first year on Advantage.

Extra benefits. Advantage plans often include benefits Original Medicare doesn't, such as some dental, vision, or hearing coverage. Those benefits go away when you return to Original Medicare, though you can buy separate policies.

Drug plan match-up. When you switch, your new plan's formulary may not cover your medications the same way. It's worth pulling up your drug list before you enroll and checking each one on the plan's formulary at medicare.gov.

When you can make the move

Two windows matter most:

• Annual Enrollment Period: Oct. 15 – Dec. 7. You can switch between Original Medicare and Medicare Advantage, change Part D plans, or add or drop drug coverage.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you can switch to a different Advantage plan or return to Original Medicare (and pick up a stand-alone Part D plan) once during this window.

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

The local picture

Elmhurst is in DuPage County, where residents typically have a wide selection of both stand-alone Part D plans and Medicare Advantage plans with drug coverage each year. The exact number of plans available changes annually, and CMS posts the current list every fall at medicare.gov. Availability is set at the county level, so a neighbor in Cook County may see a slightly different lineup than you do.