Compare Medicare Part D plans to find the best coverage for your medications. Matthew Vallier helps you navigate formularies, tiers, and costs.
Medicare Part D is the prescription drug benefit available to all Medicare beneficiaries, offered through private insurance companies approved by Medicare.
Original Medicare does not cover most prescriptions. If you have Medicare Part A and Part B without a Medicare Advantage plan that includes drug coverage, you are paying full retail price for your medications. A standalone Part D plan can save you hundreds or thousands of dollars per year.
Every Part D plan has a formulary. A formulary is the list of drugs your plan covers, organized into tiers. Different plans cover different drugs at different prices. The plan that is cheapest for your neighbor may not be cheapest for you — because you take different medications. This is why a personalized comparison is essential.
Plans change every year. Premiums, copays, deductibles, and formularies are updated annually. A plan that was perfect last year might not cover your drugs this year, or might charge significantly more for them. That is why reviewing your Part D plan during Annual Enrollment (October 15 through December 7) is critical every single year.
Not enrolling has consequences. If you do not sign up for Part D when you first become eligible and you do not have creditable drug coverage elsewhere, you will pay a late enrollment penalty that increases your monthly premium permanently. The penalty is 1% of the national base premium per month you went without coverage.
Starting in 2025, the Inflation Reduction Act introduced major changes to Medicare Part D that benefit Florida seniors:
Part D coverage is divided into four phases. Your out-of-pocket costs change as you move through each phase during the calendar year.
You pay the full cost of your drugs until you meet the annual deductible. The maximum Part D deductible for 2026 is $590, but many plans offer a $0 deductible or waive the deductible for preferred generic drugs (Tier 1). If your plan has a $0 deductible, you skip this phase entirely.
After meeting your deductible (or immediately if $0 deductible), you pay copays or coinsurance for each prescription. The plan pays the rest. This phase continues until combined total drug costs (what you pay plus what the plan pays) reach $5,030. Copays depend on formulary tier.
Thanks to the Inflation Reduction Act, the donut hole has been effectively eliminated. Your out-of-pocket costs are significantly reduced as you approach the $2,000 annual cap. You continue paying reduced copays until your total out-of-pocket spending reaches $2,000.
Once your out-of-pocket costs reach $2,000 for the year, you pay $0 for all covered drugs for the remainder of the calendar year. This $2,000 cap was introduced by the Inflation Reduction Act. This is the most significant improvement to Part D since the program began.
Part D plans organize covered drugs into tiers. Lower tiers have lower copays.
| Tier | Drug Type | Typical Copay | Examples |
|---|---|---|---|
| Tier 1 | Preferred Generic | $0–$5 | Metformin, Lisinopril, Amlodipine, Atorvastatin |
| Tier 2 | Generic | $5–$15 | Gabapentin, Losartan, Omeprazole, Sertraline |
| Tier 3 | Preferred Brand | $30–$50 | Eliquis, Jardiance, Entresto, Ozempic |
| Tier 4 | Non-Preferred Brand | 25–40% coinsurance | Brand drugs not on preferred list |
| Tier 5 | Specialty | 25–33% coinsurance | Cancer drugs, biologics, immunosuppressants |
Each Part D plan negotiates its own formulary with drug manufacturers. The same drug can be on Tier 2 (low copay) on one plan and Tier 4 (high copay) on another. Some plans require prior authorization or step therapy. This is why comparing plans based on YOUR specific medication list is critical — not just looking at the monthly premium. A plan with a $30/month premium could cost $3,000/year in copays, while a $50/month premium plan might cost only $1,200/year in copays for the same drugs.
Even if you are happy with your current plan, it may change. Medications may move tiers, be removed from formularies, get new prior authorization requirements, or the plan’s costs may increase. Matthew Vallier reviews your plan free during AEP every year.
If you go 63+ consecutive days without creditable drug coverage:
Helps people with limited income pay for Part D costs. 2026 limits: ~$22,590/year (individual), ~$30,660/year (couple). Resources below $17,220 (individual), $34,360 (couple). Can reduce Part D costs to near $0. Matt screens every client for Extra Help at no charge.
We calculate your total annual cost including premiums, deductible, copays, and coinsurance for your specific drug list. The lowest premium plan is often not the lowest total cost plan.
We verify every medication is covered, at which tier, and whether prior authorization, step therapy, or quantity limits apply. No surprises at the pharmacy.
We check your preferred pharmacy’s network status and whether using a preferred pharmacy or mail-order could lower costs. Pharmacy choice can save $50–$200+/year.
We check if you qualify for Medicare Extra Help, which can reduce Part D costs to near $0. Many eligible people do not know they qualify.
We contact you every year before AEP to review your plan. Plans change annually; your coverage should keep up. This annual review is free.
No cost to you. Matt is compensated by carriers regardless of which plan you choose, so there is no incentive to recommend one plan over another.
Florida has one of the largest Medicare populations in the country. In most Florida ZIP codes, 20 to 30+ standalone Part D plans are available, each with different formularies, premiums, deductibles, and pharmacy networks. The difference between the best and wrong plan can be $500 to $2,000+ per year.
Established 2021 by Matthew Vallier (NPN #14930062) in Coral Springs, Florida. Licensed in 27 states. Specializes in Medicare, Part D, health insurance, and life insurance.
As an independent agent, Matt compares Part D plans across all available carriers in your ZIP code. This comparison is free, takes about 15 minutes, and can be done over the phone or in person.
