How to Compare Medicare Part D Plans Before December 7

How to compare Medicare Part D plans: the short version

To compare Medicare Part D plans, start with your prescriptions, not the premium. Put every drug you take, with the dosage, and the pharmacy you actually use into Medicare’s plan comparison tool. Then look at four things for each plan: whether each drug is covered, what tier it sits on, whether it has rules like prior authorization, and what the whole year is likely to cost you at your pharmacy.

You can make that change during Medicare’s Open Enrollment, October 15 to December 7. Your plan has to receive your enrollment by December 7, and the new coverage starts January 1.

Why the plan that worked this year might not next year

Drug plans rewrite themselves every fall. Medicare’s own guidance puts it plainly: plans update their drug lists regularly and can change which drugs are covered. A medication that cost you a small copay all year can move up a tier, pick up a new rule, or drop off the list on January 1.

Your plan’s Annual Notice of Change tells you what is changing. If you have not opened it yet, our Annual Enrollment checklist covers what to look for. This post is about the next step: what to do when you want to see whether a different drug plan would serve you better.

Is my drug on the plan’s formulary?

The formulary is the plan’s drug list. Check every prescription by name and by the dosage you actually take. And check the 2027 list, not the one for this year.

If a drug you need is not on a plan’s list, that plan is usually not the one for you. There is a process for asking a plan to cover a drug it does not normally cover, called an exception, but your prescriber has to request it and support it, and you do not want your first month of a new plan to start with an argument.

How do Part D drug tiers work?

Most plans sort their drugs into tiers, and the tier decides what you pay. In the example Medicare uses, Tier 1 has the lowest copay and holds most generic drugs, and the specialty tier at the top has the highest cost for high-priced drugs. Every plan sets up its tiers a little differently, so the same drug can be Tier 2 on one plan and Tier 4 on another.

This is where the monthly premium can fool you. A plan with a low premium that puts your most expensive maintenance drug on a high tier can cost more over twelve months than a plan with a higher premium that puts it on a lower one. Run the year, not the month.

Prior authorization, step therapy and quantity limits

Being on the list is not the same as being easy to fill. Medicare describes three common coverage rules:

• Prior authorization. The plan wants approval before it will cover the drug. Your prescriber may need to show it is medically necessary.
• Step therapy. The plan wants you to try a less expensive drug first. If your prescriber believes that drug would not work or would hurt you, you can ask for an exception.
• Quantity limits. The plan covers only a set amount over a period of time, for example 30 tablets a month.

None of these are a reason to panic. They are a reason to know in advance, especially for a drug you have been stable on for years.

Do preferred pharmacies really change the price?

They can. Some plans have preferred pharmacies, which have agreed with the plan to charge you less. That means the same prescription on the same plan can cost you a different amount depending on where you fill it.

If you are loyal to a particular Jacksonville pharmacy because the pharmacist knows you and your history, that is a perfectly good reason to weigh it. Just make sure it is in the plan’s network, and check what that plan charges you there, not at a pharmacy you would never use. If you use mail order for maintenance drugs, compare that price too.

How to use the Medicare Plan Finder

Medicare’s comparison tool lives at Medicare.gov/plan-compare. Logging in with your Medicare account lets you save your drug and pharmacy lists, and it offers an option to add drugs you have filled in the last 12 months. Then:

1. Enter your ZIP code and choose drug plans, or Medicare Advantage plans with drug coverage if that is what you have.
2. Add every prescription you take. If a generic is available, the tool asks whether you want the generic or the brand.
3. Add the pharmacies you actually use. You can save up to five.
4. Compare plans on what your drugs plus the premium would cost over the year, not on premium alone.
5. Open the details for the top few and check tiers and coverage rules for each of your drugs.

The estimate is only as good as the list you give it. Leave out one expensive drug and the ranking can flip.

What is the Part D out-of-pocket cap for 2027?

For 2027, once your out-of-pocket spending on covered Part D drugs reaches $2,400, according to Medicare.gov, you pay nothing more for covered Part D drugs for the rest of the year. For 2026 that amount is $2,100. Medicare.gov also says no drug plan may have a deductible above $700 in 2027, and some plans have no deductible at all.

The cap is real protection, but it is a ceiling, not a target. Below it, what you pay month to month still depends on the plan you pick. It also only counts covered Part D drugs, which brings you right back to the formulary.

When to get a second set of eyes

If you take one or two inexpensive generics, the tool will probably give you a clear answer in a few minutes. It gets harder with several brand-name drugs, a specialty medication, or a spouse on a different set of prescriptions. If you are thinking about dropping drug coverage altogether, read about Medicare late enrollment penalties first.

Our review takes about half an hour. Bring your drug list with dosages and your plan card. We run the comparison across the carriers we work with and show you the twelve-month cost. There is no fee, and if your current plan still comes out ahead, we will tell you to keep it.

Frequently asked questions

When can I switch Medicare Part D plans?

During Open Enrollment, October 15 to December 7. Your new plan starts January 1. Outside that window you generally need a Special Enrollment Period.

What is the Part D out-of-pocket maximum in 2027?

Medicare.gov lists $2,400 for 2027. After your out-of-pocket spending on covered Part D drugs reaches that amount, you pay nothing more for covered Part D drugs that year.

What if my drug is not on a plan’s formulary?

You or your prescriber can ask the plan for an exception, and your prescriber has to submit a supporting statement. It is usually simpler to choose a plan that already covers the drug.

Is the plan with the lowest premium the cheapest?

Not always. Tiers, the deductible and your pharmacy can make a low-premium plan cost more over a year. Compare estimated yearly costs with all your drugs entered.