What Does Medicare Part D Cover in Florida?

Medicare Part D is the prescription drug benefit -- and for many Florida seniors, it is one of the most important parts of their Medicare coverage. But Part D can also be one of the most confusing.

Here is a plain-English guide to what Part D covers, how it works, and how to make sure you are getting the best deal on your prescriptions.

Medicare Part D is optional prescription drug coverage offered through private insurance companies that contract with Medicare. You can get Part D coverage two ways:

1. Standalone Part D plan -- Added to Original Medicare (Parts A and B) or a Medicare Supplement plan
2. Medicare Advantage plan with drug coverage -- Most Medicare Advantage plans include Part D coverage

Part D covers a wide range of prescription drugs, but not every drug is covered by every plan. Each Part D plan has a formulary -- a list of covered drugs organized into tiers.

Typical drug tiers:

• Tier 1: Generic drugs -- lowest copay
• Tier 2: Preferred brand-name drugs -- moderate copay
• Tier 3: Non-preferred brand-name drugs -- higher copay
• Tier 4: Specialty drugs -- highest copay or coinsurance
• Tier 5: Select specialty drugs -- highest cost sharing

The specific drugs on each tier vary by plan. This is why it is critical to compare Part D plans based on your actual medications -- not just the monthly premium.

Part D does not cover everything. Common exclusions include:

• Over-the-counter drugs (even if prescribed)
• Drugs used for weight loss or gain
• Fertility drugs
• Drugs for cosmetic purposes
• Most vitamins and supplements
• Drugs covered under Medicare Part A or Part B (like chemotherapy)

Part D costs vary by plan and by the drugs you take. Here are the main cost components:

Monthly premium: Varies by plan -- can range from under $10 to over $100/month in Florida.

Annual deductible: Up to $590 in 2026 for standard Part D plans. Some plans have $0 deductibles for certain tiers.

Copays and coinsurance: What you pay when you pick up a prescription, based on the drug's tier.

Out-of-pocket maximum: In 2026, once you reach $2,100 in out-of-pocket drug costs, you pay $0 for the rest of the year (thanks to the Inflation Reduction Act).

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

The most important factor in choosing a Part D plan is whether your specific medications are covered -- and at what cost.

Steps to find the best Part D plan:

1. Make a list of all your current prescriptions (drug name, dosage, frequency)
2. Use Medicare's Plan Finder tool at medicare.gov to compare plans based on your drugs
3. Check the formulary for each plan you are considering
4. Compare total annual costs (premium + deductible + copays), not just the monthly premium
5. Check your preferred pharmacy is in the plan's network

If you do not enroll in Part D when you first become eligible and you go 63 or more consecutive days without creditable drug coverage, you will face a permanent late enrollment penalty.

The penalty is 1% of the national base beneficiary premium for every month you went without coverage -- added to your monthly premium for life.

Bottom line: Even if you take no medications, enroll in a low-cost Part D plan to protect yourself from the penalty.

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 review at calendly.com/themedicaredude/75.