Medicare Part D

Two ways to get drug coverage in De Pere: how Part D and Advantage compare

De Pere, Wis. — If you're sorting out Medicare drug coverage for 2027, you'll quickly run into a fork in the road. One path keeps Original Medicare and pairs it with a stand-alone Part D drug plan. The other bundles your drug coverage inside a Medicare Advantage plan. Both can cover the same medicines, but the machinery behind them is different — and that difference matters if you ever switch from one to the other.

Medicare Part DDe Pere, WI

The two structures, side by side

Stand-alone Part D is a drug-only insurance policy you add on top of Original Medicare (Parts A and B). Your medical care flows through Original Medicare, and your prescriptions flow through the separate Part D plan. Many people who choose this path also buy a Medigap (Medicare Supplement) policy to help with Part A and B cost-sharing.

A Medicare Advantage plan (Part C) replaces the way Original Medicare pays for your care. Most Advantage plans include prescription drug coverage — often called an "MA-PD" — so your hospital, doctor, and drug benefits all sit inside one plan, with one member card and one set of rules.

De Pere is in Brown County, where residents can choose from both stand-alone Part D plans and Medicare Advantage plans that include drug coverage. Availability is set at the county level, so two neighbors on the same street see the same list of options.

What's the same either way

The core Part D rules Congress wrote apply to both paths. The key figures for 2027:

• An annual cap on what you pay out of pocket for covered drugs: $2,100 in 2026 and $2,400 in 2027.
• A maximum deductible of $615 in 2026 and $700 in 2027 (plans can charge less).
• No more "donut hole." Part D now has three phases instead of four.
• The option to use the Medicare Prescription Payment Plan, which lets you spread your drug costs across the calendar year in monthly bills instead of paying at the pharmacy counter.
• Higher-income enrollees may owe an IRMAA surcharge on Part D; for 2026, IRMAA begins above $109,000 in income for a single filer.

Every Part D plan — stand-alone or inside an Advantage plan — must also publish a formulary (its list of covered drugs) and follow Medicare's rules on appeals and exceptions.

What changes when you move between them

Switching from stand-alone Part D to a Medicare Advantage plan isn't just a drug-plan change — it's a change to how all of your Medicare works.

• Networks and referrals. Original Medicare lets you see any provider who accepts Medicare. Most Advantage plans use provider networks, and some require referrals to see specialists. If you have doctors in Green Bay, Appleton, or across the state line, check whether they're in-network before you move.
• Medigap. If you drop a Medigap policy to join Advantage, you generally don't have a guaranteed right to buy Medigap again later. Wisconsin has its own Medigap rules, so it's worth talking to the state SHIP before you make a change.
• Prior authorization. Advantage plans often use prior authorization for medical services more than Original Medicare does. Drug prior authorization exists on both paths.
• Extra benefits. Advantage plans may include benefits Original Medicare doesn't cover, but those benefits vary by plan and can change year to year.

Going the other direction — from an Advantage plan back to Original Medicare plus stand-alone Part D — is allowed during the right windows, but you'll want to line up a Part D plan and think through Medigap before you make the move.

When you can make the switch

Two windows matter most:

• Annual Enrollment Period, Oct. 15 – Dec. 7. Any Medicare beneficiary can join, drop, or switch a Part D plan or Medicare Advantage plan. Changes take effect Jan. 1.
• Medicare Advantage Open Enrollment Period, Jan. 1 – March 31. If you're already in a Medicare Advantage plan, you can switch to another Advantage plan or return to Original Medicare (and pick up a stand-alone Part D plan). This window is not open to people on Original Medicare.

Special Enrollment Periods can also open up after certain life events, like moving out of your plan's service area or losing other creditable drug coverage.

Where to get personal help in De Pere

Because the "right" path depends on your prescriptions, your doctors, your budget, and whether you have Medigap, one-size-fits-all advice doesn't work. For unbiased, free help:

• Medicare.gov has a Plan Finder that lets you enter your drugs and pharmacy and compare both stand-alone Part D and Medicare Advantage plans available in Brown County.
• 1-800-MEDICARE (1-800-633-4227) is open 24/7.
• Wisconsin SHIP — the state's free counseling program, sometimes called the Medigap Helpline — offers one-on-one help by phone and through local partners serving De Pere and the Green Bay area.