Medicare Part D

Two Ways to Cover Your Prescriptions Under Medicare in 2026

# Two Ways to Cover Your Prescriptions Under Medicare in…

FUQUAY-VARINA, N.C. — If you take even one regular prescription, the way you get drug coverage through Medicare matters. And for 2027, there are still two main paths: a stand-alone Part D plan that sits alongside Original Medicare, or drug coverage rolled into a Medicare Advantage plan. They cover the same program benefits at the core, but the structure around them — how you see the doctor, how claims flow, what happens if you switch — is quite different.

The two structures, side by side

With stand-alone Part D, you keep Original Medicare (Parts A and B) for hospital and doctor services, and you add a separate prescription drug plan from a private insurer. You end up with two cards: your red-white-and-blue Medicare card, plus a Part D card for the pharmacy.

With a Medicare Advantage plan that includes drug coverage (often called MA-PD), one private plan handles your hospital, medical, and drug benefits together. You typically use one card for everything, and the plan generally has a network of doctors and pharmacies.

Both paths must follow the same Part D program rules set by CMS — including the out-of-pocket cap on covered drugs ($2,100 in 2026, $2,400 in 2027) and the maximum deductible ($615 in 2026, $700 in 2027).

What the Part D rules mean for either path in 2027

A few program-level facts apply no matter which door you pick:

• The coverage gap ("donut hole") is gone as of 2025. Part D now has three phases: deductible, initial coverage, and catastrophic.
• Once your out-of-pocket spending on covered drugs hits the annual cap — $2,100 in 2026 and $2,400 in 2027 — you pay $0 for the rest of the year on those covered drugs.
• The Medicare Prescription Payment Plan lets you spread your drug costs across the calendar year in monthly installments, at no extra charge. You can ask any Part D or MA-PD plan to opt in.
• Higher-income enrollees pay an IRMAA surcharge on Part B and Part D premiums; for 2026, that starts above $109,000 for a single filer.

Fuquay-Varina is in Wake County — here's what that means

Medicare plan availability is set at the county level, not the city. Fuquay-Varina sits mostly in Wake County (with a slice in Johnston County), so the menu of stand-alone Part D plans and Medicare Advantage plans you can join depends on which county your home address is in. If you're comparing plans on Medicare.gov, entering your ZIP code will pull the right list for your address.

Wake County typically offers a wide selection of both stand-alone Part D and MA-PD plans, but the specific carriers and plan designs change each year. That's why it's worth looking again during the Annual Enrollment Period, even if you liked your current plan last year.

What changes if you move between the two paths

Switching isn't just a paperwork change — it can reshape how you use Medicare day to day.

Moving from stand-alone Part D + Original Medicare to a Medicare Advantage plan: Your medical coverage generally shifts from Original Medicare to the Advantage plan. That usually means using a network, possibly getting referrals, and following the plan's rules for prior authorization. You'd drop your stand-alone Part D plan (you can't keep both if the MA plan already includes drugs — you'd be disenrolled from Advantage).

Moving from Medicare Advantage back to Original Medicare + stand-alone Part D: You go back to using your red-white-and-blue card for doctors and hospitals, and you'd add a separate Part D plan to keep your drug coverage. Two big things to think about: whether you want (and can qualify for) a Medigap supplement policy to help with Original Medicare's cost-sharing, and whether you'll enroll in a Part D plan on time to avoid a late-enrollment penalty.

When you can make the switch

• Annual Enrollment Period: Oct. 15 – Dec. 7. Anyone with Medicare can join, switch, or drop a Part D plan or an Advantage plan. Changes take effect Jan. 1.
• Medicare Advantage Open Enrollment: Jan. 1 – March 31. If you're already in an Advantage plan, you can switch to another Advantage plan or return to Original Medicare (and add 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.

How to think about which path fits you

There's no universal "right" answer. Some questions that tend to matter:

• Do you want to keep seeing specific doctors, and are they in a plan's network?
• Do you travel often, or split time between states? Original Medicare travels broadly; Advantage networks may be regional.
• Do you already have — or want — a Medigap policy? Those pair only with Original Medicare.
• Are your prescriptions on the plan's formulary, and at what tier?
• Would monthly smoothing through the Prescription Payment Plan help your budget?

Your local State Health Insurance Assistance Program (SHIP) can walk through these questions with you at no cost. In North Carolina, that program is called SHIIP.