Prescription Drug Coverage
That Actually Covers Your Medications.

Most Medicare Advantage plans include Part D drug coverage built in — called MAPD plans. If your MA plan already includes drug coverage, you do not need a separate Part D plan, and in most cases you cannot enroll in one without losing your MA coverage. If you have a Medicare Advantage plan without drug coverage (called MA-only, which is rare), you may be able to add a standalone Part D plan. We confirm which type you have before recommending anything.

This is exactly what we do for South Carolina clients. Give us your current medication list and we run a plan comparison showing which plans cover your drugs, what your expected annual total cost would be under each plan, and which pharmacies are in-network. The analysis includes premiums, deductibles, copays at every coverage phase, and pharmacy pricing. This is free and typically takes about 20 minutes.

The penalty is 1% of the national base beneficiary premium for each month you went without Part D or other creditable drug coverage after first becoming eligible. It is permanent and added to your monthly Part D premium for as long as you have Part D. For example, going 24 months without coverage adds a 24% permanent premium surcharge. If you had creditable coverage through an employer or union, those months do not count toward the penalty.

You can change Part D plans during Annual Enrollment (October 15 through December 7) each year for coverage starting January 1. Mid-year changes are generally not allowed except in specific Special Enrollment Period situations — qualifying for Extra Help, moving out of the plan's service area, entering or leaving a nursing facility, or losing creditable coverage. We help SC clients evaluate whether a mid-year SEP applies to their situation.

Part D has three coverage phases in 2026: the deductible phase (you pay 100% of drug costs up to the plan's deductible, capped at $590 by Medicare), the initial coverage phase (you pay copays or coinsurance), and the catastrophic phase (you pay $0 for covered drugs after hitting the new $2,000 annual out-of-pocket cap). The old coverage gap or "donut hole" was eliminated under the Inflation Reduction Act. The $2,000 cap is a major change for SC seniors on expensive medications.

Extra Help (also called the Low-Income Subsidy or LIS) is a federal program that helps Medicare beneficiaries with limited income and resources pay for Part D premiums, deductibles, and copays. Eligible South Carolinians may qualify for full or partial Extra Help, which can reduce drug costs to just a few dollars per prescription. Qualifying for Extra Help also triggers a Special Enrollment Period to change Part D plans. We help SC clients determine eligibility and apply through the Social Security Administration.

Under federal rules in effect for 2026, covered insulin products are capped at $35 for a one-month supply on all Part D plans and Medicare Advantage drug plans. Adult vaccines recommended by the Advisory Committee on Immunization Practices (ACIP) are covered at $0 cost-sharing, including the shingles vaccine, RSV vaccine, and others. These caps apply across all SC Part D plans, regardless of the plan's normal copay structure for those medications.

Most Part D plans have two tiers of in-network pharmacies. Preferred pharmacies offer the lowest copays — sometimes $0 for generics — while standard pharmacies are in-network but charge higher copays for the same drug. Out-of-network pharmacies are not covered except in emergencies. The list of preferred pharmacies varies dramatically by plan. We always confirm which of your local SC pharmacies are preferred versus standard before recommending a plan, because the difference can be substantial over a year.