Medicare and Prescription Drug Costs: How to Lower Your Expenses

Prescription drug costs are one of the biggest financial concerns for Florida seniors on Medicare. The good news: there are several proven strategies to lower what you pay at the pharmacy -- and many seniors are leaving money on the table by not using them.

The single most impactful thing you can do to lower your drug costs is choose a Part D plan that covers your specific medications at the lowest tier.

Every Part D plan has a formulary -- a list of covered drugs organized into cost tiers. The same drug can be on Tier 1 (low copay) in one plan and Tier 3 (high copay) in another.

How to find the best plan for your drugs:

1. Make a complete list of your medications (name, dosage, frequency)
2. Use Medicare's Plan Finder at medicare.gov to compare plans based on your specific drugs
3. Look at total annual costs (premium + deductible + copays), not just the monthly premium
4. Check that your preferred pharmacy is in the plan's network

I do this comparison for my clients every year during Annual Enrollment Period -- and I frequently find plans that save them hundreds of dollars annually.

Starting in 2025, Medicare Part D has an annual out-of-pocket cap. In 2026 that cap is $2,100. Once you reach $2,100 in covered drug costs, Medicare pays 100% for the rest of the year.

If you take expensive specialty medications, this cap can save you thousands of dollars compared to previous years.

The Extra Help program (also called the Low Income Subsidy or LIS) is a federal program that helps people with limited income and resources pay for Part D costs.

Extra Help can cover:

• Part D premiums
• Deductibles
• Copays and coinsurance

Who qualifies: In 2026, individuals with income below about $22,590 and resources below $17,220 may qualify (higher limits for married couples).

Many eligible seniors do not apply because they do not know the program exists. If you think you might qualify, contact Social Security at 1-800-772-1213 or apply at ssa.gov.

Generic drugs contain the same active ingredients as brand-name drugs and are just as effective -- but they cost significantly less. Ask your doctor if a generic version of your medication is available.

In most Part D plans, generics are on Tier 1 or Tier 2, meaning your copay can be as low as $0-$10.

Most Part D plans offer lower copays for a 90-day supply through mail-order pharmacy compared to a 30-day supply at a retail pharmacy. If you take maintenance medications (drugs you take regularly for chronic conditions), mail-order can save you money and the hassle of monthly pharmacy trips.

Even with Medicare Part D, sometimes the GoodRx price for a medication is lower than your plan's copay. You cannot use GoodRx and Medicare at the same time, but for certain drugs -- especially generics -- it is worth checking.

Important: If you use GoodRx instead of your Part D plan, the purchase does not count toward your out-of-pocket maximum or deductible.

Drug formularies change every year. A medication that was on Tier 1 last year may move to Tier 3 this year -- dramatically increasing your costs. Review your Part D plan every Annual Enrollment Period (October 15 - December 7) to make sure you still have the best plan for your medications.

For brand-name drugs that are not well-covered by your Part D plan, the manufacturer may offer a patient assistance program that provides the drug at low or no cost. Ask your doctor or pharmacist about programs for your specific medications.

As an independent broker, I compare Part D plans from all major carriers to find the one that covers your specific medications at the lowest total cost. This service is completely free to you.

Call me at (386) 871-3858 or schedule a free drug plan review at calendly.com/themedicaredude/75.