Medicare Part D

Part D or Medicare Advantage drug coverage in Nashua: what shifts when you change lanes

NASHUA, N.H. — With Medicare's Annual Enrollment Period running through Dec. 7, people across Hillsborough County are weighing a choice that trips up even careful shoppers: whether to get their prescription coverage through a stand-alone Part D plan paired with Original Medicare, or through a Medicare Advantage plan that folds drug coverage in.

The two paths can look similar at the pharmacy counter, but they are built differently. And moving between them changes more than just your drug card.

Two structures, one goal

Medicare drug coverage — Part D — is optional, but almost everyone with Medicare needs it in some form. There are two ways to get it.

The first is a stand-alone Part D plan, sold by a private insurer to work next to Original Medicare (Parts A and B). You keep Original Medicare for your hospital and doctor care and add a separate plan just for prescriptions.

The second is a Medicare Advantage plan with drug coverage (often called an MA-PD). Advantage plans replace how you receive your Part A and Part B benefits and, in most cases, roll prescription coverage into the same plan. One card, one insurer, one set of rules.

Nashua is in Hillsborough County, where both stand-alone Part D plans and Medicare Advantage plans with drug coverage are offered by multiple carriers. The number of choices in each category is public information on Medicare.gov's Plan Finder.

What the two paths share

No matter which lane you pick, the core Part D rules set by CMS apply:

• The maximum deductible a Part D plan can charge in 2026 is $615. Some plans set it lower.
• Once you and your plan have spent enough on covered drugs, you hit the $2,100 annual out-of-pocket cap. After that, covered drugs cost you nothing for the rest of the year.
• The old coverage gap ("donut hole") is gone as of 2025. There are now three payment phases instead of four.
• You can opt into the Medicare Prescription Payment Plan, which lets you spread your drug costs into monthly bills instead of paying big amounts at the pharmacy.
• Higher-income enrollees pay an IRMAA surcharge on Part D; in 2026, those surcharges start above $109,000 in income for a single filer.

Those rules are program-wide. They do not change based on which insurer's plan you pick or whether the coverage is stand-alone or bundled.

What actually changes when you switch

This is where people get surprised. The drug coverage piece is only part of the story.

Moving from Original Medicare + Part D into a Medicare Advantage plan generally means:

• You now use the Advantage plan's provider network for doctors and hospitals.
• Referrals, prior authorization, and in-network rules may apply.
• Your monthly premium picture changes (you still owe your Part B premium).
• Your drug formulary — the list of covered medications — is set by the new plan.

Moving from Medicare Advantage back to Original Medicare + a stand-alone Part D plan generally means:

• You go back to seeing any provider who accepts Medicare.
• You may want a Medigap (Medicare Supplement) policy to help with Original Medicare's cost-sharing.
• Depending on your state and your timing, you may not have a guaranteed right to buy any Medigap plan you want. In some states, insurers can use medical underwriting outside of specific windows.
• You pick a stand-alone Part D plan separately.

That Medigap question is the one many people miss. In New Hampshire, Medigap protections outside of your initial enrollment window are limited, so it is worth checking the rules before you assume you can switch back easily.

When you can make the change

Two windows matter most:

• Annual Enrollment Period: Oct. 15 – Dec. 7. Anyone with Medicare can join, drop, or switch a Part D plan or a Medicare Advantage plan. Changes take effect Jan. 1.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you are already in a Medicare Advantage plan on Jan. 1, you get one chance during this window to switch to a different Advantage plan or drop back to Original Medicare (and pick up a stand-alone Part D plan).

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

How to think it through

There is no universally "right" answer between the two structures. The trade-off is usually about how you want to receive care and how predictable you want your costs to be.

A few honest questions to ask yourself:

• Do my current doctors take Original Medicare, and are they in the Advantage plans I am considering?
• Which of my prescriptions are on each plan's formulary, and at what tier?
• Do I travel or live part of the year outside New Hampshire?
• If I later want to move back to Original Medicare, what will my Medigap options look like?

Medicare.gov's Plan Finder lets you enter your drug list and ZIP code to compare specific plans side by side. That is the tool built for this comparison.