Part D — when the right plan depends entirely on what's in your medicine cabinet.

Part D is the trickiest piece of Medicare because the "right plan" depends entirely on your specific medications. Two clients on identical Medicare Supplements may end up on completely different Part D plans because their drug lists differ. A client taking three generic medications and a name-brand inhaler will have very different optimal-plan economics than a client taking the same three generics plus a $4,800-a-year specialty injection.

The Medicare.gov plan finder, run honestly with your actual medications, your actual pharmacy, and your zip code, ranks every Part D plan in your area by total annual cost (premium + deductible + copays through the year). It produces a number we can compare across plans. That number — your modeled annual cost — is the right basis for the decision, not the headline premium.

We re-run that comparison every AEP for every client. Most clients stay on the same plan year over year. A meaningful minority — maybe 15–25% in any given fall — switch. The reason is almost always either a formulary change (the plan moved one of your medications to a higher tier) or a medication change (you started a new prescription mid-year that the old plan handles badly).

How Part D works

The Four Phases of a Part D Plan Year (2026)

Annual deductible: Up to $615 (most plans). You pay 100% of drug costs until you hit it.

Initial coverage phase: After the deductible, you pay your tier-based copays/coinsurance until your total drug spending reaches $5,030.

Coverage gap (donut hole) — REDESIGNED: The IRA eliminated the traditional gap. You now pay no more than 25% of drug costs in this phase; once your out-of-pocket reaches $2,100, you enter catastrophic.

Catastrophic coverage: $0 copay on covered drugs for the rest of the calendar year. Your annual Part D out-of-pocket is capped at $2,100 in 2026.

Medicare Prescription Payment Plan (optional): Smoothes your $2,100 cap into even monthly payments across the year if you prefer.

What we do for you

The Part D Conversation, Every Year

You bring your full medication list — name, dose, frequency, preferred pharmacy

We enter it into the Medicare.gov plan finder with your zip code

The tool ranks every available Part D plan by total annual cost

We discuss the top 3–5 plans and explain why each ranks where it does

We file the enrollment if you change plans; we print and hand you the comparison if you stay

We re-run this comparison every AEP, every year, for the life of the client relationship

A client switched her cholesterol medication from Lipitor to atorvastatin in March. By October her old Part D plan was the wrong plan — the new generic placed her in a different tier and her preferred pharmacy was an out-of-network for that particular tier. AEP is the moment we re-run that comparison. Every year.

Stand-alone Part D carriers we use

Wellcare Value Script. Often the lowest-premium standalone Part D plan in North Carolina ($0–$1/month in some zip codes). Formulary is tighter than competitors — best for clients on common generics with few brand-name medications.

Humana Walmart Value Rx. Lowest cost for clients whose preferred pharmacy is Walmart. Strong tier-1 generic pricing. The Humana Premier plan is a step up for clients on more expensive medications.

Aetna SilverScript. Three SilverScript tiers (SmartRx, Choice, Plus) covering a range of medication profiles. Aetna's pharmacy network is large; for clients who use a non-Walmart, non-CVS pharmacy, SilverScript Choice is often the right answer.

Cigna SecureRxRider. Cigna's mid-tier Part D plan. Pairs well with Cigna Healthspring Advantage clients who later switch to a Supplement.

Mutual of Omaha Rx. Newer standalone Part D entrant. Competitive for clients on moderate-tier brand-name medications. We model it routinely when comparing.

Frequently asked questions