Prescription Drug Coverage
That Actually Covers Your Medications.

Most Medicare Advantage plans available in the Midlands include Part D drug coverage built in — called MAPD plans. If your MA plan already includes drug coverage, you do not need a separate Part D plan, and in most cases you cannot enroll in one without losing your MA coverage. If you have a Medicare Advantage plan without drug coverage (called MA-only, which is rare), you may be able to add a standalone Part D plan. We confirm which type you have before recommending anything.

This is exactly what we do for Midlands clients. Give us your current medication list and we run a plan comparison showing which plans cover your drugs, what your expected annual total cost would be under each plan, and which Midlands pharmacies are in-network. The analysis includes premiums, deductibles, copays at every coverage phase, and pharmacy pricing at your preferred location — whether that is a local Lexington pharmacy, CVS, Walgreens, Walmart, Publix, or another. This is free and typically takes about 20 minutes.

The penalty is 1% of the national base beneficiary premium for each month you went without Part D or other creditable drug coverage after first becoming eligible. It is permanent and added to your monthly Part D premium for as long as you have Part D. For example, going 24 months without coverage adds a 24% permanent premium surcharge. If you had creditable coverage through an employer or union, those months do not count toward the penalty.

You can change Part D plans during Annual Enrollment (October 15 through December 7) each year for coverage starting January 1. Mid-year changes are generally not allowed except in specific Special Enrollment Period situations — qualifying for Extra Help, moving out of the plan's service area, entering or leaving a nursing facility, or losing creditable coverage. We help Midlands clients evaluate whether a mid-year SEP applies to their situation.

Part D has three coverage phases in 2026: the deductible phase (you pay 100% of drug costs up to the plan's deductible, capped at $590 by Medicare), the initial coverage phase (you pay copays or coinsurance), and the catastrophic phase (you pay $0 for covered drugs after hitting the new $2,000 annual out-of-pocket cap). The old coverage gap or "donut hole" was eliminated under the Inflation Reduction Act. The $2,000 cap is a major change for Midlands seniors on expensive medications.

Extra Help (also called the Low-Income Subsidy or LIS) is a federal program that helps Medicare beneficiaries with limited income and resources pay for Part D premiums, deductibles, and copays. Eligible Midlands residents may qualify for full or partial Extra Help, which can reduce drug costs to just a few dollars per prescription. Qualifying for Extra Help also triggers a Special Enrollment Period to change Part D plans. We help Midlands clients determine eligibility and apply through the Social Security Administration.

Under federal rules in effect for 2026, covered insulin products are capped at $35 for a one-month supply on all Part D plans and Medicare Advantage drug plans. Adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered at $0 cost-sharing, including the shingles vaccine, RSV vaccine, and others. These caps apply across all Midlands Part D plans, regardless of the plan's normal copay structure for those medications.

Most Part D plans have two tiers of in-network pharmacies. Preferred pharmacies offer the lowest copays — sometimes $0 for generics — while standard pharmacies are in-network but charge higher copays for the same drug. Out-of-network pharmacies are not covered except in emergencies. The list of preferred pharmacies varies dramatically by plan. We always confirm which of your local Midlands pharmacies (whether that is a Lexington pharmacy, CVS, Walgreens, Walmart on Augusta Highway, or Publix) are preferred versus standard before recommending a plan, because the difference can be substantial over a year.