Medicare Part D

Medicare Part D is prescription drug coverage offered through private insurance companies approved by Medicare. It helps pay for generic and brand-name prescription drugs at pharmacies. Part D can be obtained two ways: as a standalone Prescription Drug Plan (PDP) added to Original Medicare, or bundled into a Medicare Advantage plan with drug coverage (MA-PD). Each plan has its own formulary (list of covered drugs), premiums, deductibles, and pharmacy network. Original Medicare (Parts A and B) does not cover most outpatient prescription drugs, making Part D essential for most beneficiaries.

Part D costs in 2026 include:

• Monthly premium — averages $34.50/month for standalone plans in 2026, down from $38.31 in 2025. Premiums vary widely by plan.
• Annual deductible — up to a maximum of $615 in 2026. Some plans have no deductible.
• Copays/coinsurance — your share of each prescription cost, based on the drug's tier.
• Out-of-pocket maximum — $2,100 in 2026. Once reached, you pay $0 for covered drugs for the rest of the year.

Brad compares plans across multiple carriers to find the lowest total cost for your specific medications.

In 2026, Part D has been simplified to three stages:

• Deductible stage — you pay the full cost of drugs until your deductible (up to $615) is met. Some plans skip this stage for certain tiers.
• Initial coverage stage — after your deductible, you pay 25% coinsurance for covered drugs until your total out-of-pocket spending reaches $2,100.
• Catastrophic coverage stage — once you hit $2,100 out-of-pocket, you pay $0 for covered Part D drugs for the rest of the calendar year.

The old "donut hole" coverage gap has been eliminated. 2026 is significantly more protective than prior years.

No, Part D is not mandatory. However, if you go without creditable prescription drug coverage when first eligible and later decide to enroll, you will face a permanent late enrollment penalty. The penalty is calculated as 1% of the national base beneficiary premium ($38.99 in 2026) multiplied by the number of uncovered months — and it's added to your premium for as long as you have Part D. If you have other creditable drug coverage (such as through an employer, VA, or TRICARE), you may delay Part D without penalty. Not sure if your coverage qualifies? Brad can review it for free — call (920) 251-4969.

Yes, enrolling in at least a low-premium Part D plan is strongly recommended even if you currently take no medications. Here's why:

• If you develop a health condition and need prescriptions later, you may face a late enrollment penalty if you didn't enroll when first eligible.
• A low-premium plan costs very little now and protects you from the penalty permanently.
• The $2,100 out-of-pocket cap in 2026 provides significant protection if you ever need expensive medications.

Brad can find you a low-cost plan that keeps you protected without breaking the bank.

Choosing the right Part D plan requires comparing several factors specific to your situation:

• Formulary coverage — confirm your specific drugs are covered and at which tier.
• Pharmacy network — make sure your preferred pharmacy is in-network (preferred pharmacies offer lower costs).
• Total cost — add up premiums + deductible + estimated copays for your medications, not just the monthly premium.
• Mail-order options — many plans offer 90-day mail-order supplies at lower cost.

This is exactly what Brad does for free — he enters your medications, dosages, and preferred pharmacy into a plan comparison tool across all available Wisconsin carriers and finds you the best total value. Call (920) 251-4969 to get started.

Working with Brad makes enrolling in Part D simple and free:

1. Gather your medication list — bring your current prescriptions, dosages, and preferred pharmacy.
2. Brad compares plans — he shops multiple top carriers available in Wisconsin to find the plan with the best coverage at the lowest total cost for your specific drugs.
3. Enroll during your eligible window — Initial Enrollment Period (around your 65th birthday), Annual Enrollment Period (Oct 15–Dec 7), or a Special Enrollment Period if you qualify.
4. Brad handles the paperwork — he walks you through the application and submits your enrollment at no cost to you.

Ready? Call (920) 251-4969 or request a free review online.

The Medicare Prescription Payment Plan (MPPP) is a newer benefit available in 2026 that allows Part D enrollees to spread their out-of-pocket drug costs into capped monthly payments throughout the year, rather than paying large amounts all at once at the pharmacy. All Medicare Part D plans are required to offer this option. Starting in 2026, if you were enrolled in the MPPP in 2025, you will be automatically re-enrolled each year unless you opt out — no action needed. Important note: the MPPP helps manage cash flow but does not lower your total drug costs or save you money. Ask Brad if this program makes sense for your situation.

Extra Help (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 — including premiums, deductibles, and copays. If you qualify, you could pay little to nothing for your prescription drugs. Eligibility is based on income and assets. In 2026, individuals with incomes up to 150% of the federal poverty level may qualify. You apply through Social Security. Brad can help you determine if you or a family member may qualify — this is one of the most underutilized benefits in Medicare.

Yes — 2026 marks a major milestone in Medicare drug pricing. For the first time, Medicare has negotiated lower prices on 10 high-cost prescription drugs, including medications for arthritis, blood clots, cancer, and diabetes. These negotiated prices took effect January 1, 2026 and must be honored by all Medicare Advantage and standalone Part D plans. The savings are estimated to reduce out-of-pocket spending by $1.5 billion across all beneficiaries in 2026. Additionally, GLP-1 weight-loss medications from Eli Lilly and Novo Nordisk are expected to become available at lower prices through Medicare starting in July 2026. Brad stays current on all drug pricing changes so he can find you the best plan for your medications every year.