Medicare Part D — Prescription Drug Coverage 2026
Medicare Part D Plans in
Northeast Florida
The 2026 $2,100 out-of-pocket cap is the biggest change to Part D in decades. I run your full medication list against every plan in your ZIP — finding the lowest total annual cost, not just the lowest premium.
Major Part D Changes for 2026
The Inflation Reduction Act continues to reshape Part D. Here's what changed and what it means for you.
$2,100 Out-of-Pocket Cap
Once you spend $2,100 on covered drugs, you pay $0 for the rest of the year. This replaces the old "donut hole" structure entirely.
Insulin Capped at $35/Month
All covered insulin products are capped at $35/month per prescription. No deductible applies to insulin.
Vaccines at $0
All ACIP-recommended vaccines (shingles, flu, pneumonia, COVID, RSV) are covered at $0 under Part D.
Smoothed Premium Payments
The Medicare Prescription Payment Plan lets you spread drug costs evenly across the year instead of paying large amounts at once.
Manufacturer Discounts Count
Drug manufacturer discounts now count toward your out-of-pocket maximum — a major benefit for specialty drug users.
Formulary Changes
Plans can change their formularies each year. A drug covered at Tier 2 this year may move to Tier 4 next year. Annual review is essential.
Part D by County: Local Pharmacy Guide
Preferred pharmacy networks vary by plan and by county. Using a non-preferred pharmacy can cost you significantly more — here's what to know in each area.
Flagler County
Palm Coast, Bunnell, Flagler Beach
Local pharmacies: Walgreens (Palm Coast Pkwy), CVS (Town Center Blvd), Winn-Dixie Pharmacy, Publix Pharmacy (multiple locations)
Palm Coast's rapid growth has brought more pharmacy options, but preferred pharmacy networks still vary significantly by plan. Residents in Bunnell and Flagler Beach have fewer in-network options and should verify coverage before enrolling.
Local tip: Several Palm Coast residents are enrolled in plans where their Publix pharmacy is not a "preferred" pharmacy — meaning they pay higher copays than necessary. A quick review can often save $30–$60/month.
Volusia County
Daytona Beach, Ormond Beach, Port Orange, DeLand, New Smyrna Beach
Local pharmacies: Walgreens, CVS, Publix, Winn-Dixie, Walmart Pharmacy, Beachside Pharmacy (independent)
Volusia County has the most pharmacy competition in Northeast Florida. Independent pharmacies like Beachside Pharmacy in Daytona Beach are preferred pharmacies in some plans, offering lower copays than chain pharmacies. The $2,100 out-of-pocket cap in 2026 is especially impactful for Volusia residents on high-cost specialty drugs.
Local tip: If you take a specialty drug (biologics, cancer medications, MS drugs), the 2026 $2,100 Part D cap is a game-changer. I can calculate your exact annual drug cost under each plan.
Duval County
Jacksonville, Jacksonville Beach, Atlantic Beach, Neptune Beach
Local pharmacies: Walgreens, CVS, Publix, Winn-Dixie, Walmart, Costco Pharmacy, BJ's Pharmacy
Jacksonville's size means more plan options and more pharmacy choices. Costco and BJ's pharmacies are preferred in several plans and often offer the lowest copays for generic medications. Mail-order pharmacy (90-day supply) is available on all Part D plans and typically cuts costs by 30–50% for maintenance medications.
Local tip: Jacksonville residents on 3+ maintenance medications almost always save money switching to 90-day mail-order. I set this up for clients at no charge.
St. Johns County
St. Augustine, Ponte Vedra Beach, Nocatee, Fleming Island
Local pharmacies: Walgreens, CVS, Publix, Winn-Dixie, Walmart Pharmacy (St. Augustine)
St. Johns County's newer communities (Nocatee, Shearwater) have limited local pharmacy options. Many residents rely on mail-order or drive to St. Augustine or Jacksonville for preferred pharmacies. Residents on brand-name medications should pay close attention to formulary placement — the same drug can be Tier 3 on one plan and Tier 5 on another.
Local tip: Nocatee and Ponte Vedra residents often overlook mail-order pharmacy. For maintenance drugs, a 90-day mail-order supply through your plan's preferred pharmacy can cut your annual drug costs significantly.
How I Compare Part D Plans for You
Collect your full medication list
Every drug, every dose, every frequency — including over-the-counter drugs that have prescription equivalents.
Run your list against every plan
I use Medicare's Plan Finder tool plus carrier-direct data to compare total annual cost — premium + deductible + copays.
Check your preferred pharmacy
I verify whether your pharmacy is preferred, standard, or out-of-network for each plan — this alone can change the math significantly.
Identify mail-order savings
For maintenance medications, 90-day mail-order supply typically saves 30–50% over retail. I set this up for you.
Review every year
Formularies change annually. I contact every client before October 15 to review their plan for the coming year.
The Most Common Part D Mistake
Most people choose the plan with the lowest monthly premium. That's almost always the wrong move.
A plan with a $0 premium might charge you $80/month for a drug that costs $12/month on a plan with a $35 premium. The total annual cost — premium + deductible + copays — is the only number that matters.
I've seen clients save $1,200–$2,400/year just by switching to the right Part D plan. The review takes about 20 minutes and costs nothing.
Part D Frequently Asked Questions
What is the Medicare Part D out-of-pocket cap in 2026?
In 2026, the Medicare Part D out-of-pocket cap is $2,100. Once you reach this amount in covered drug costs, you pay $0 for the rest of the year. This is a major improvement from prior years and is especially significant for people on specialty or high-cost medications.
Do I need Part D if I have Medicare Advantage?
Most Medicare Advantage plans include Part D drug coverage (called MAPD plans). If your Medicare Advantage plan includes drug coverage, you do not need a separate Part D plan. However, if you have a Medicare Advantage plan without drug coverage, or if you have Original Medicare with a Medigap supplement, you need a standalone Part D plan.
What is the Part D late enrollment penalty?
If you go 63 or more consecutive days without creditable drug coverage after becoming eligible for Medicare, you'll pay a permanent late enrollment penalty. The penalty is 1% of the national base beneficiary premium for each month you went without coverage — and it lasts for life. In 2026, the base premium is $36.78, so even 12 months without coverage adds about $4.41/month permanently.
Can I change my Part D plan every year?
Yes — during the Annual Enrollment Period (October 15 – December 7), you can switch Part D plans. Changes take effect January 1. I review my clients' drug plans every year because formularies, premiums, and pharmacy networks change annually.
What is a formulary and why does it matter?
A formulary is the list of drugs a plan covers and at what tier (cost level). The same medication can be on Tier 1 ($0–$5 copay) on one plan and Tier 4 ($50+ copay) on another. Running your full medication list against every plan's formulary is the most important step in choosing a Part D plan.
Find the Right Part D Plan for Your Medications
Bring your medication list. I'll run it against every plan in your ZIP code and show you the total annual cost — not just the premium. Free, no obligation.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY: 1-877-486-2048) to get information on all of your options.
Not affiliated with or endorsed by the U.S. government or the federal Medicare program. This is an advertisement for insurance. William Gray and affiliated licensed agents are independent insurance agents, not government employees or representatives. Medicare has neither reviewed nor endorsed this information.
Not all plans or types of coverage may be available in your area. Plan availability, benefits, and premiums vary by county and ZIP code. Enrollment in any plan depends on contract renewal. Benefits, premiums, and cost-sharing may change on January 1 of each year.
Independent Agent & Compensation Disclosure. William Gray is an independent licensed insurance agent (FL License #W690237) and is not employed by or exclusively affiliated with any single insurance company. William is compensated by insurance carriers when you enroll in a plan. This compensation does not affect the premium you pay — your premium is the same whether you enroll through a broker or directly with the carrier. Affiliated agents are independent contractors solely responsible for their own conduct and representations.