Coverage by Plan Type
How prescription drug coverage works under each type of Medicare plan.
Original Medicare (Parts A & B)
LimitedOriginal Medicare does not cover most outpatient prescription drugs. Part A covers drugs administered during a hospital stay (IV medications, anesthesia). Part B covers a narrow set of drugs given in a clinical setting, such as chemotherapy infusions, dialysis drugs, and certain injectable medications administered by a provider.
Medicare Part D
CoveredPart D is the dedicated prescription drug benefit. It is available as a standalone Prescription Drug Plan (PDP) added to Original Medicare, or bundled into a Medicare Advantage plan. Part D covers most FDA-approved prescription drugs organized into tiers, each with different cost-sharing. You must enroll in a Part D plan or face a permanent late enrollment penalty.
Medicare Advantage (Part C)
Usually IncludedMost Medicare Advantage plans include Part D drug coverage (called MAPD plans). If your Advantage plan includes drug coverage, you do not need a separate Part D plan. A small number of Advantage plans do not include drug coverage: in that case you can enroll in a standalone PDP.
Medigap (Medicare Supplement)
Not CoveredMedigap plans do not cover prescription drugs. If you have Original Medicare plus a Medigap plan, you need to enroll in a separate standalone Part D plan to get drug coverage. Medigap plans sold after January 1, 2006 are prohibited from including drug coverage.
How Medicare Part D Works
Part D is the Medicare prescription drug benefit, available since 2006.
Medicare Part D is a voluntary prescription drug benefit offered through private insurance companies that contract with Medicare. Plans vary by premium, deductible, formulary (list of covered drugs), and pharmacy network. Every Part D plan must cover at least two drugs in each drug category, but the specific drugs and cost-sharing tiers differ between plans.
Part D plans use a formulary: a tiered list of covered drugs. Each tier has a different cost-sharing amount. Generic drugs are typically in lower tiers with lower copays, while specialty drugs are in higher tiers with higher coinsurance. Before enrolling, you should verify that your specific medications are on the plan's formulary and check which tier they fall in.
The Part D late enrollment penalty applies if you go 63 or more consecutive days without creditable drug coverage after your Initial Enrollment Period ends. The penalty is 1% of the national base beneficiary premium for each month without coverage, added permanently to your monthly Part D premium. At 2026 rates, even a 12-month gap adds roughly $3.70 per month: permanently.
The Late Enrollment Penalty Is Permanent
Unlike a one-time fee, the Part D penalty is added to your monthly premium for as long as you have Part D coverage. Enrolling on time: or maintaining creditable coverage through an employer plan: is the only way to avoid it. See the full Part D penalty explanation.
Drug Tiers and Typical Costs
Most Part D plans use a five-tier formulary structure. Costs vary by plan.
| Tier | Drug Type | Typical Cost |
|---|---|---|
| Tier 1 | Preferred Generic | $0 to $5 copay |
| Tier 2 | Generic | $5 to $15 copay |
| Tier 3 | Preferred Brand | $35 to $47 copay |
| Tier 4 | Non-Preferred Brand | $60 to $100 copay |
| Tier 5 | Specialty | 25% to 33% coinsurance |
Costs are typical ranges. Actual amounts depend on your specific plan. Always verify your drug's tier before enrolling.
Key 2026 Part D Changes
The Inflation Reduction Act made significant changes to Part D that took full effect in 2026.
$2,100 Out-of-Pocket Cap
Starting in 2026, your annual out-of-pocket costs for Part D are capped at $2,100. Once you reach this limit, you pay $0 for covered drugs for the rest of the year. This eliminates the catastrophic coverage phase.
$35 Insulin Cap
All Part D plans must cap insulin cost-sharing at $35 per month per covered insulin product. This applies regardless of which coverage phase you are in.
Medicare Prescription Payment Plan
Beneficiaries can now opt into a payment plan that spreads their out-of-pocket drug costs evenly across the year rather than paying large amounts at the start of the year when deductibles apply.
$590 Maximum Deductible
The maximum Part D deductible in 2026 is $590. Not all plans charge the maximum: some plans waive the deductible for lower-tier drugs. Compare plans carefully during AEP.
Other Benefits Often Missing from Original Medicare
Prescription drugs are not the only gap in Original Medicare. Dental and hearing coverage are also excluded from Parts A and B.
Part D Plans in Brandon and the Tampa Bay Area
Local guidance for residents of Hillsborough County and surrounding areas.
Serving Brandon, Tampa, Riverview, Valrico, and Hillsborough County
Hillsborough County residents have access to a wide range of Part D standalone plans and Medicare Advantage plans with drug coverage. The number of available plans varies by ZIP code: residents in Brandon, Riverview, and Valrico typically have 20 or more Part D plan options during the Annual Enrollment Period.
Formularies change every year. A drug that was covered at a low tier in 2025 may have moved to a higher tier or been removed from the formulary entirely in 2026. This is why reviewing your plan annually during AEP (October 15 through December 7) is critical, even if you are happy with your current plan.
Greg Wohl and the MIP team help Brandon and Tampa Bay area residents compare Part D plans side by side, verify that their specific medications are covered, and identify the plan with the lowest total annual drug cost: not just the lowest premium. Call 813-699-5559 for a no-cost plan comparison.
Frequently Asked Questions
Common questions about Medicare prescription drug coverage.
Not Sure Which Part D Plan Is Right for You?
The right plan depends on your specific medications, your pharmacy, and your budget. Greg Wohl compares every available plan in your ZIP code at no cost to you.