Medicare Part D

Switching Between Part D and Advantage? Here's What Changes

# Switching Between Part D and Advantage? Here's What Changes

KANSAS CITY, Mo. — If you take a regular prescription, how you get Medicare drug coverage matters as much as what it costs. And this fall, more Kansas City retirees are asking a practical question as they weigh 2027 coverage: should drug coverage sit inside a Medicare Advantage plan, or ride alongside Original Medicare as a stand-alone Part D policy? The two paths look similar on paper, but they behave very differently — especially if you decide to switch between them.

Two structures, one goal

Medicare drug coverage — Part D — comes in two shapes.

The first is a stand-alone Part D plan (PDP). You keep Original Medicare (Parts A and B) for hospital and doctor visits, and you add a separate prescription drug plan from a private insurer. Two ID cards, two sets of rules, two premiums.

The second is a Medicare Advantage plan with drug coverage (MA-PD). A private insurer bundles your hospital, medical, and drug benefits — and often extras like dental or vision — into one plan with one card. Kansas City is in Jackson County, where residents have both routes available and can choose either structure during enrollment.

Both follow the same federal drug rules. No Part D plan can charge a deductible higher than $615 in 2026 or $700 in 2027, and once your out-of-pocket drug spending hits $2,100 in 2026 (or $2,400 in 2027), you pay nothing more for covered drugs the rest of the year. The old "donut hole" coverage gap was eliminated in 2025, so there are now three simpler payment phases.

What actually differs

The mechanics of your drug benefit look a lot alike no matter which path you pick — same cap, same phases, same option to use the Medicare Prescription Payment Plan to spread costs across the year. Where the two structures diverge is in the surrounding coverage.

With Original Medicare plus a stand-alone Part D plan, you can see any provider in the country who accepts Medicare. There's no network for medical care. Your drug plan has its own network of pharmacies and its own formulary (the list of covered drugs).

With a Medicare Advantage plan, both your medical care and your drugs run through one insurer's network. That often means referrals, prior authorizations, and a service area that ties you to local doctors and pharmacies. The trade-off is a simpler package and, for many, extra benefits Original Medicare doesn't include.

What changes when you switch

Switching directions isn't just an insurance shuffle — it changes how you access care.

Moving from Original Medicare + PDP into a Medicare Advantage plan: Your stand-alone drug plan ends automatically when your Advantage plan begins. You'll get drug coverage through the new plan, but you may need to check whether your current medications and pharmacies are still covered under its formulary and network.

Moving from Medicare Advantage back to Original Medicare: This is the switch that trips people up. Dropping the Advantage plan does not automatically give you drug coverage. You have to enroll in a stand-alone Part D plan during the same window, or you risk a late enrollment penalty that follows you for as long as you have Part D. You may also want to look into a Medigap (Medicare Supplement) policy to help with Original Medicare's cost-sharing, though rules for buying one after your initial window can vary by state.

When you can make the move

Two main windows matter each year:

• Annual Enrollment Period, Oct. 15 – Dec. 7: Anyone can change Part D plans, join or leave Medicare Advantage, or move between structures. Coverage starts Jan. 1.
• Medicare Advantage Open Enrollment, Jan. 1 – March 31: If you're already in an Advantage plan, you get one more chance to switch to a different Advantage plan or return to Original Medicare with a stand-alone Part D plan.

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

A note on higher-income enrollees

If your income is above $109,000 as a single filer (or $218,000 filing jointly) in 2026, you'll pay an IRMAA surcharge on top of your Part D premium — the same surcharge applies whether the drug coverage comes through a stand-alone plan or an Advantage plan. That's worth knowing before you assume one route is automatically cheaper.