Medicare Part D

Does your drug plan sit beside or inside Medicare?

CANBY, Ore. — If you take even one prescription, the way your Medicare drug coverage is built matters. In 2027, Canby residents still choose between two very different structures: a stand-alone Part D plan that sits alongside Original Medicare, or drug coverage folded into a Medicare Advantage plan. They can look similar at the pharmacy counter, but the plumbing behind them is not the same — and moving from one to the other changes more than just your drug card.

Two structures, one goal

Both paths are designed to help pay for prescriptions, but they are built differently.

A stand-alone Part D plan is a drug-only policy. Most people who choose it also have Original Medicare (Part A and Part B) for hospital and doctor care, and many add a Medigap policy to help with out-of-pocket medical costs. The Part D plan handles prescriptions and nothing else.

A Medicare Advantage plan with drug coverage (often called an MA-PD) is a single plan from a private insurer that replaces how you get your Part A and Part B benefits and usually includes Part D drug coverage in the same package. One card, one plan, one insurer handling everything.

Canby is in Clackamas County, where both paths are available. The county-level plan counts you see on Medicare.gov reflect what is offered where you live.

What the 2027 rules do — and don't — change

Some Part D rules are set by Medicare itself and apply no matter which structure you pick:

• The out-of-pocket cap for covered drugs is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing for covered prescriptions the rest of the year.
• The maximum deductible is $615 in 2026 and $700 in 2027. Plans can charge less, but not more.
• The coverage gap (the old "donut hole") is gone as of 2025. Part D now has three phases instead of four.
• The Medicare Prescription Payment Plan lets you spread drug costs across the calendar year in monthly bills, at no added charge, if you choose to opt in.

What each individual plan charges — premiums, copays, which drugs are on the formulary, which pharmacies are preferred — is set by the insurer and varies. That is true whether the drug coverage is stand-alone or built into an Advantage plan.

What actually changes if you switch paths

Moving between stand-alone Part D and an MA-PD is not just a drug decision. A few things move with it:

Your medical coverage changes too. Leaving Original Medicare for a Medicare Advantage plan means you use the Advantage plan's network and rules for doctors, hospitals and specialists. Going the other direction returns you to Original Medicare, where you can see any provider who accepts Medicare.

Your Medigap situation can shift. If you drop a Medigap policy to join an Advantage plan, you may not be able to get the same Medigap policy back later without medical underwriting, depending on state rules and your timing. This is worth checking before you switch.

Your formulary and pharmacy network reset. Every plan has its own drug list and preferred pharmacies. A medication that was on Tier 2 in one plan may sit on a different tier — or not be listed at all — in the next.

Your enrollment window matters. During the Annual Enrollment Period (Oct. 15 – Dec. 7), you can move between almost any combination. During Medicare Advantage Open Enrollment (Jan. 1 – March 31), you can switch from one Advantage plan to another or drop Advantage and return to Original Medicare with a stand-alone Part D plan, but you cannot use this window to move from Original Medicare into an Advantage plan.

Higher-income households: the IRMAA note

If your income is above $109,000 as a single filer (or $218,000 filing jointly) using 2026 thresholds, you may pay an income-related monthly adjustment amount, known as IRMAA, on top of your Part D premium. This applies to your Part D coverage whether it is stand-alone or built into a Medicare Advantage plan. Social Security notifies you if it applies.

How to think it through

There is no single "right" path — the point is to match the structure to how you actually use care. A few questions worth asking:

• Do you want one plan handling everything, or separate pieces you can change independently?
• How important is keeping a specific doctor, specialist or hospital?
• Are your medications on the plan's formulary, and at what tier?
• If you have a Medigap policy, what happens to it if you switch?

Your local State Health Insurance Assistance Program (SHIP) counselor can walk through these questions with you at no cost. In Oregon, SHIP is called SHIBA.