Part D: the plan with the lowest premium is rarely the cheapest
Every Part D plan covers a different list of drugs at different prices through different pharmacies. The only way to pick one is to price your actual prescriptions through each plan for the full year. That's the comparison I run.
Part D is Medicare prescription drug coverage from a standalone plan or built into a Medicare Advantage plan. Every plan has its own drug list and pharmacy network, out-of-pocket costs are capped at $2,100 in 2026 and $2,400 in 2027, and going 63 days without creditable drug coverage triggers a permanent penalty. The right plan is the one that covers your prescriptions cheapest at your pharmacy, checked every fall.
Two ways to get Part D
- A standalone Part D plan (PDP) — paired with Original Medicare, usually alongside a Medigap policy. Every 2027 stand-alone plan sold in New York is listed, each linked to its Medicare.gov page.
- Built into a Medicare Advantage plan (MA-PD) — most Advantage plans in the Capital Region include drug coverage; you can't add a separate Part D plan on top.
Why "cheapest premium" is a trap
A plan's monthly premium is often a small part of what you actually spend on drugs over a year. Part D premiums for 2027 explains why premiums are changing. The real numbers are set by:
- The formulary — the list of drugs the plan covers. If one of yours isn't on it, you pay full price or go through an exception process.
- Tiers — the same drug can be tier 2 on one plan and tier 4 on another, at three or four times the copay.
- The deductible — some plans charge it on all tiers, some skip it for generics.
- Pharmacy network — "preferred" pharmacies get lower copays; your local pharmacy may or may not be one.
- Restrictions — prior authorization, quantity limits and step therapy on specific drugs.
I enter your exact medications and dosages, and your pharmacy, into a comparison tool and rank plans by total yearly cost. The ordering is very often the opposite of the premium ordering.
What changed recently
Part D has been reshaped over the last few years, mostly in beneficiaries' favor (the 2026 deductible and cap sit with every other Medicare figure on the costs page):
- The old coverage gap ("donut hole") is gone.
- There is now an annual cap on out-of-pocket drug costs — $2,100 in 2026 and $2,400 in 2027, adjusted each year — after which covered drugs cost you nothing for the rest of the year.
- The Medicare Prescription Payment Plan lets you spread out-of-pocket drug costs across the remaining months of the year instead of paying a large amount at the pharmacy in January. Monthly bills can change as you fill prescriptions, and it doesn't reduce what you pay in total. How it works and how to opt in is in the questions below.
- Covered insulin is capped at $35 for a month's supply, in every Part D and Advantage plan, and recommended adult vaccines are free (the shingles vaccine included). GLP-1 drugs are covered for diabetes. For weight loss, Part D still can't pay, but from July 1, 2026 to December 31, 2027 the Medicare GLP-1 Bridge offers certain weight-loss GLP-1s for a $50 monthly copay to Part D enrollees who meet CMS's criteria, outside the Part D benefit (Ozempic, Wegovy, Zepbound and the GLP-1 Bridge).
The flip side is that some plans have raised premiums or tightened formularies to absorb these changes, which makes the yearly re-check more important, not less.
The late-enrollment penalty, in dollars
Skipping Part D "because I don't take anything" is a costly Medicare mistake. The penalty is 1% of the national base premium ($38.99 in 2026) for every month you went without creditable coverage, added to your premium for as long as you have Part D. Two years without coverage is about $9.40 a month, forever, on top of whatever plan you eventually buy. For 2027 the base premium rises to $41.33 (CMS, July 28, 2026), and the penalty is recalculated on it every year, so it grows with the base.
What would a late-enrollment penalty cost?
Enter the months you went without coverage after you were first eligible. Employer coverage from a company with 20 or more employees doesn't count as a gap for Part B; any creditable drug coverage doesn't count for Part D.
- Part B penalty
- —per month, for as long as you have Part B
- Part D penalty
- —per month, for as long as you have Part D
- Together, over 10 years
- —at 2026 rates; premiums rise most years
Based on the 2026 standard Part B premium ($202.90) and Part D base premium ($38.99). Penalties are recalculated each year as those figures change. Part B penalties usually end at 65 for people who had Medicare because of disability; otherwise both are permanent. An estimate, not a determination — Social Security and your Part D plan set the actual amounts.
The penalty calculator also has its own page, for Part B too.
Plans change on January 1
Formularies, tiers and pharmacy networks are reset every year. A plan that priced your prescriptions perfectly this year can be a poor fit next year with nothing on your side having changed. I re-run every client's drug list during the Annual Enrollment Period.
Help with drug costs for New Yorkers
Two programs stack with Part D, and a third gets you into one of them automatically:
- Extra Help (the federal Low-Income Subsidy) — lowers premiums, deductibles and copays substantially, and removes the late-enrollment penalty. Applied for through Social Security.
- EPIC — New York's program for residents 65+, with income limits well above Extra Help's. For lower incomes it can pay toward your Part D premium; for everyone it lowers copays once the Part D deductible and any EPIC fee or deductible are met.
- The Medicare Savings Program pays the Part B premium and brings Extra Help with it automatically; New York counts income only (QMB and QI income limits and how to apply).
If you're anywhere near the limits, read the help-paying page before you choose a plan — qualifying changes which plans make sense.
What I need from you
- Your medication names, strengths and how often you take them (a photo of the labels works).
- The pharmacy you'd like to keep using.
- Your ZIP code and whether you're on Original Medicare or an Advantage plan.
That's enough for a full-year comparison. Send it over or call and I'll come back with the two or three plans worth choosing between.
- Part D late enrollment penalty (medicare.gov) — 1% per month; $38.99 base premium in 2026
- Medicare Part D 2027 national average monthly bid amount and base beneficiary premium (CMS, July 28, 2026) — $41.33 base beneficiary premium for 2027; premium stabilization demonstration ends after 2026
- Announcement of CY 2027 Medicare Advantage capitation rates and Part C and D payment policies, Table V-2 (CMS, April 2026) — 2027 Part D out-of-pocket threshold $2,400
- Final CY 2026 Part D redesign instructions (CMS) — $2,100 out-of-pocket cap
- Medicare Prescription Payment Plan (medicare.gov)
- Medicare Prescription Payment Plan: how it works (medicare.gov) — monthly bills spread across the calendar year, no cost, doesn't lower total; read October 14, 2026
- Using the Medicare Prescription Payment Plan (medicare.gov) — changing plans ends participation; leave any time; no interest or fees; read October 16, 2026
- Insulin costs (medicare.gov) — $35 monthly cap
- EPIC program (NY Department of Health)
- Medicare GLP-1 Bridge (CMS) — July 1, 2026 – Dec 31, 2027; $50 copay; outside the Part D benefit; read October 15, 2026
We do not offer every plan available in your area. Currently we represent 10 organizations which offer 81 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (TTY 1-877-486-2048) is available 24 hours a day, 7 days a week. Insurers' legal names and home offices: carriers page.
Common questions
Short answers to what people ask before they call.
Still have a question? Call (518) 902-8822 or book a call.
Do I need Part D if I take no medications?
You need Part D or other creditable coverage from the time you're first eligible, or you'll pay a late-enrollment penalty for as long as you have Part D later. The penalty is 1% of the national base premium for every month you went without, permanently. A low-premium plan is the usual hedge.
What counts as creditable coverage?
Drug coverage at least as good as standard Part D — most employer and union plans, VA coverage, TRICARE, and Medicare Advantage plans with drug coverage. Your plan should send you a notice each year saying whether it's creditable. Keep it.
What is the Part D out-of-pocket cap in 2026 and 2027?
$2,100 in 2026. For 2027 it rises to $2,400, the figure CMS set in its April 2026 rate announcement. Once your out-of-pocket spending on covered drugs reaches the cap, you pay nothing more for covered drugs for the rest of the year. In New York, EPIC can lower what you pay on the way there: after any Part D deductible (and, on its Deductible Plan, an EPIC deductible), covered prescriptions cost $3 to $20 each. You can also spread your costs over the year through the Medicare Prescription Payment Plan, which changes the timing, not the total.
What is the Medicare Prescription Payment Plan (M3P)?
An optional way to pay your out-of-pocket drug costs in monthly amounts spread across the calendar year, instead of paying the pharmacy at the counter. You keep paying your plan premium as usual, and your drug plan, or your Medicare Advantage plan if it includes drug coverage, sends you a monthly bill for your prescriptions. It doesn't lower what you pay in total, and there's no cost to join. Every plan offers it and joining is voluntary; you opt in by contacting your plan, and I can help you decide whether it's worth it for your prescriptions.
Does the Medicare Prescription Payment Plan carry over into 2027?
Not if you change plans. Medicare says that leaving your plan or switching to a new drug plan or Advantage plan with drug coverage ends your participation, so if you switch during the Annual Enrollment Period you opt in again with the new plan for January. You can leave at any time by contacting your plan, any balance you owe is still billed, and there is no interest or fee even on a late payment. For 2027 the amount it spreads is limited by the $2,400 out-of-pocket cap.
Can I change my Part D plan mid-year?
Normally only during the Annual Enrollment Period (Oct 15 – Dec 7), unless you qualify for a Special Enrollment Period — moving, losing other coverage, or getting Extra Help are common ones. People with Extra Help can change plans more often.
What is EPIC?
New York's own program for residents 65 and over: the Elderly Pharmaceutical Insurance Coverage program. It works alongside Part D as secondary coverage — lowering copays after the Part D deductible, and helping with the premium at lower incomes — and the income limits are higher than most people expect. Details on the help-paying page.
Want a note before the next enrollment window?
One email a few days before each Medicare enrollment window opens — Annual Enrollment in October, Advantage Open Enrollment in January — with the dates and what to have ready. Nothing else, ever; reply "stop" to come off the list.
Price your prescriptions
Send your drug list and pharmacy; I'll run it across the Part D plans available to you for the whole year.