How to Choose the Best Medicare Part D Plan for Your Needs

But for a stand-alone Part D plan, you can narrow your scope.

If you create a sign-in now on the plan finder, you won’t have to start from scratch each time you sit down for research. You can use the website without logging in.

The tool will ask for your ZIP code to locate plans available in your area, which is in one of 39 regions that include all the states, the District of Columbia and the five largest U.S. territories — American Samoa, Guam, Northern Mariana Islands, Puerto Rico and U.S. Virgin Islands. Nine of the regions in the continental U.S. contain more than one state.

You’ll answer a couple of questions before adding your prescriptions, their strength and number of doses over a certain period, such as 30 days, 60 days or 90 days.

Then you’ll select up to five pharmacies near you, which can include a mail-order option.

3. Recognize the costs you’ll pay out of pocket

The list of plan options generated from your information will be rich in details, maybe overwhelming. But pay close attention to your total drug and premium costs for the year.

In 2027, your out-of-pocket prescription costs will be capped at $2,400 versus the $2,100 limit for 2026. For most people, that total includes any deductible, copayments and coinsurance for medications on your plan’s list of covered drugs.

Any monthly premium you pay won’t be counted toward that $2,400 maximum. And any medicines not part of your plan’s formulary also are excluded.

With a deductible — $700 maximum in 2027 versus $615 max for 2026 — you’ll pay all that your plan charges you until you meet this annual limit. But some plans have a zero-dollar deductible, and others fall in between the two extremes.

Prices vary. Here’s why. You probably know that plans negotiate privately with drug manufacturers and pharmacies on what they will pay, similarly to what the government is doing to lower prescription costs. After you pick a plan, you won’t be paying list price for your prescriptions.

What you will pay is based on the agreements your plan arranges. Plans organize their drug lists into four or five pricing tiers, and sometimes the last two tiers are combined:

• Tier 1, preferred generic drugs
• Tier 2, nonpreferred generic drugs
• Tier 3, preferred brand-name drugs
• Tier 4, nonpreferred brand-name drugs
• Tier 5, specialty drugs

You can discover how your medicines are classified after putting them in the Medicare Plan Finder. If you pick three plans from the results to compare side by side, you’ll see whether your meds are covered under the Drug coverage & costs heading.

If you go back to your search results and tap the See plan details button for each interesting plan, you’ll find the estimated drug costs at each pharmacy you chose, including changes as you meet any deductible and move toward the annual out-of-pocket limit. If you scroll down and tap the + View more drug coverage button, you’ll see the general costs by drug tier before you reach the cap.

Scroll a little farther, and you’ll find out the tier each of your meds falls under.

Whether a generic or brand-name drug is preferred often depends on those behind-the-scenes negotiations among plans, pharmaceutical companies and drugstores. The outcome can differ depending on the plan, even within the same parent company.

Expect copayments, a set up-front fee, for both types of generics.

You may see some plans offer free preferred generics that keep chronic conditions such as high blood pressure or high cholesterol at bay. Usually, the low-cost drugs offered with no copay can prevent strokes, heart disease and other serious conditions in the long run, saving you and the health care system money later on.

Federal law gives insulin special treatment, a $35-a-month out-of-pocket cap in any Medicare plan. Injectable insulin is covered under Part D.

Insulin delivered through a durable insulin pump falls under Part B. It also has a $35-a-month cap, but that copayment won’t count toward your Part D spending limit because it’s covered under a different part of Medicare.

Coinsurance, a percentage of a drug’s price that you pay, is becoming a common way to share costs with plan enrollees who need brand-name and specialty-tiered medicines.

Where you fill a script matters. You’ll also notice varying costs among pharmacies near you, depending on whether a plan has classified them as preferred, in-network or out-of-network.

Generally, preferred in-network pharmacies, which might be mail-order operations, are the least expensive. But that’s not always true.

That’s why checking a mix of drugstores in the plan finder, including local businesses, national chains and online-only stores, can help you seek out the least expensive option.

4. Check for restrictions on your medications

Making sure your prescriptions are included in a plan’s formulary is the foundation for finding the right plan for your needs.

But as drug prices go up, insurers have put methods in place to keep their costs down and determine whether a medication is appropriate. You may encounter:

• Prior authorization
• Quantity limits
• Step therapy

Prior authorization adds a step between your doctor’s prescription and a plan’s coverage. It means that you or your doctor must contact your plan for permission before a pharmacy can fill certain, usually expensive, prescriptions.

Quantity limits may come into play if your doctor has you taking a medication long term, longer than the plan considers normal to treat your condition or in an amount outside of its standards.

Step therapy requires you to try a less expensive medicine that’s been proven effective for people with your condition before the plan will cover the more expensive prescribed drug.

All these constraints can be appealed multiple times.

So checking Medicare’s Plan Finder to see how a plan treats your prescriptions can save you angst. You’ll find the information deep in the details page for each plan.

Under Drug Coverage | + View more drug coverage, scroll to Other drug information. It’s listed in the table that shows the tier for each of your meds.

5. Look at the star ratings for each plan of interest

The Centers for Medicare and Medicaid Services gives both stand-alone Part D and Medicare Advantage plans star ratings. Five stars, ★ ★ ★ ★ ★, is the best and the most rare.

A caveat. The ratings, which you’ll see in the upper right corner of your search results, don’t look at individual plans. Instead, they assess private insurers’ Medicare contracts with CMS, contracts that include many plans, says Claire Noël-Miller, senior strategic policy adviser for Medicare at the AARP Public Policy Institute.

In recent years, what makes them less relevant to choosing a stand-alone Part D plan has been a lack of widely available plans with four or five stars.

Only 2 drug-plan contracts out of 40, 5 percent, received the most desirable five stars in 2026. Both belong to insurers with fewer than 10,000 enrollees and limited geographic footprints, CMS says.

Fewer than 1 in 4 contracts earned four stars or more.

About 7 in 10 enrollees were in average-performance, three-star plans, according to CMS data. The agency alerts consumers about plans that have lower than a three-star rating for three years in a row with a low-performing icon.

A way out. If you do find yourself in a plan with a rating of fewer than three stars for the past three years, you don’t have to wait for open enrollment season. You can switch to another plan with at least a three-star rating anytime, similar to the way you can buy a five-star plan all year if you find one.

CMS will send you a notice in late October that you’re in a low-performing plan.

While you can compare plans online with Medicare’s Plan Finder, to make a switch you won’t be able to finish the process online. You’ll have to call 800-MEDICARE, 800-633-4227.

6. See if you qualify for financial assistance

Even with the annual out-of-pocket cap on drug costs, which debuted in 2025, you may find a couple thousand dollars in prescription expenses tough to absorb into your budget.

Extra Help. If you have limited financial resources, you may qualify for the Extra Help program, also called the Part D low-income subsidy. If you’re already receiving help from your state through a Medicare Savings Program or full Medicaid, you can get Extra Help automatically, though you should check to make sure the paperwork is in order.

It limits your copays on prescriptions to $5.80 for generics and $14.40 for brand-name drugs in 2027, up from $5.10 for generics and $12.65 for brand names in 2026. And qualifying for Extra Help will eliminate any Part D late enrollment penalty you might have while you’re in the program.

Deferred payments. The Medicare Prescription Payment Plan has no income limit. It acts like a zero-interest installment loan that allows you to spread out your drug costs for the remainder of the year after you enroll, and it’s especially handy if you expect to hit the out-of-pocket cap early.

Free, unbiased advice. Your State Health Insurance Assistance Program (SHIP), which has local staffing in your state or territory, offers personalized help with sorting through all your financial and plan options. The toll-free national number, 877-839-2675, can connect you with your local SHIP, or you can find your area’s SHIP through an online directory.

7. Now you’re ready to enroll

To enroll, head back to Medicare’s Plan Finder and locate the plan you like best. Click the Enroll button.

Supply your info. You’ll need your Medicare number and the effective dates for Medicare Parts A and B. You’ll also be asked about other health insurance and when you want the new coverage to begin.

The application screens will guide you through the remaining steps.

8. Don’t set it and forget it

Your Part D policy isn’t always static, even for one year. The insurer can add or remove drugs from its formulary throughout the year but must give you 60 days’ notice before the changes take effect.

Every September, you’ll receive a document in the mail called an annual notice of change that lays out your plan’s revisions for the next calendar year.

Be aware of the potential for big changes:

• A premium increase
• A deductible increase
• New rules on copayments or coinsurance
• A total revamp of the list of covered medications
• New requirements before prescriptions are approved
• Pharmacies that are withdrawing or changing status
• Even modifications to a plan’s service area

You don’t have to reenroll or inform the plan if you’re staying, but don’t be surprised. Assess your needs and options starting every October.

Other plans have been making changes too. You can do more comparison shopping during open enrollment Oct. 15 to Dec. 7 to decide whether a different plan would be a good move for you.

This story, originally published Oct. 9, 2014, has been updated with additional step-by-step guidance for finding the best stand-alone Part D prescription plan.