My diabetes medication is super expensive, and I've heard horror stories about Part D not covering what people need. Should I go standalone Part D or get it through a Medicare Advantage plan?

Question

Diana Garner · Accepted Answer

Before making any decision, you should review both options. Check the cost of your medications with a standalone Part D plan and the Medicare Advantage plans with drug coverage.

When on Medicare, you have the option to select a Medicare Supplement with a Standalone Part D plan (prescription drug plan) or select a Medicare Advantage plan with prescription drug coverage.  

The option you choose will depend on your budget and income. I would never recommend someone have just Medicare A & B with a Standalone Part D plan because then they would be responsible for all of the Part A & B deductibles and copays.

Once you decide which option is best for you based on your budget, you can search for the Standalone Part D or Medicare Advantage plan with drug coverage that is best for you based on your medications.  

As a broker, it is my responsibility to help my clients find the perfect fit.

Gary Church · Answer

The reality is that some medications are very expensive. Whether you are on original Medicare with a stand-alone Drug plan or have a Medicare Advantage plan, the issue is that Congress must allow Medicare to negotiate all drug pricing for Medicare patients. Big Pharma needs to be accountable for controlling the cost of its drugs.

Answered by Gary Church on June 18, 2025

Broker Licensed in Ca, AZ, NV & TX

Answered by Gary Church Medicare Insurance Agent

Steve and Sue Brauer · Answer

Hi, thanks for watching. So the question is this: this person's diabetic medication is really expensive, and they've heard horror stories about Part D prescription drug plans not covering what people need. They're asking if they should do a standalone Part D drug plan or get it through Medicare Advantage. So the answer to this is pretty simple. You have to do your homework on this. You have to figure out what medication you take, if there's any alternative that would work better, and find out what the formulary is on whatever plan you're signing up with. Whether it's a standalone Part D prescription drug plan with original Medicare or if it's a Medicare Advantage plan, that's the crux of all this. You have to make sure that your medication is covered on the plan that you enroll into. It's that simple.

Mark Bilgere · Answer

As of 2025, CMS has made some great progress in protecting beneficiaries from those "Horror Stories". The main change is the implementation of a $2,000 Maximum Out of Pocket annual limit.

If you select an Advantage plan, your drug plan is usually built into the plan. This means you will not have an additional Part D drug premium. You may still have a drug deductible and you will have drug cost. The good news is agents and brokers can look up your medications and tell you exactly what they will cost in each Advantage plan.

If you select a Medicare Supplement (Medigap) you will then need to add a stand alone Part D plan. This most likely will have an additional premium in addition to a deductible and the cost of the drugs. However, your agent can also look up all of your medications in the different Part D plans and tell you what your drug cost will be for the year.

Norman Smith · Answer

Firstly, my recommendation is to stay away from the MA plans, as your healthcare will be limited as to choices on your health. Especially when there is NO UNDERWRITING involved in your Open Enrollment, get the best while you can and keep control of your health always. MA means giving the control and the choices to a private company who doesn’t even know you!!!
The Prescriptions and pricing are based on a Tier level through the Medicare Part D. Depending on the plan chosen, your drugs will have different pricing. For 2025, between Premium and covered drug costs, you will not have more than $2,000 out of pocket expense. This is a great improvement over previous years!
If they can be administered at your PCP’s or other Medical Professionals office, they would be covered under your Part B. So, do what you can there!

William Lawler · Answer

I am diabetic and I am on a Medicare Advantage plan. Insulin costs are capped at $35/mo. Other meds, like Ozempic, are not inexpensive, but they are available.

Terri Reagin · Answer

whether you go through a Stand alone Part D or Medicare Advantage the prescription drug coverage should be the same. The modifiers are going to be the doctor and hospital coverage

Christopher Boyd · Answer

If you have a medicare supplement, medicare part d will cover your diabetes drugs, and you will not have to deal with the network restrictions of a medicare advantage plan. Additionally, if you've had a medicare vantage plan for more than one year, you may not be able to get back to a medicare supplement with pre-existing conditions under most circumstances. If you are eligible for the extra help savings program through the Social Security Administration, or medicaid, or pharmaceutical assistance through your state. You may be able to get assistance that way.

Answered by Christopher Boyd on November 19, 2025

Agent Licensed in IN, KY, MI, OH, PA & TN

Answered by Christopher Boyd Medicare Insurance Agent

Jonathan Potter · Answer

Choosing between a supplement and Medicare Advantage is a individual choice. One option is not perfect for everyone. I would get with your agent and have them evaluate both options with the following information: List of Doctors, dentists and any medications that you take. They can take that information and calculate the best option for you.

Answered by Jonathan Potter on June 9, 2025

Broker Licensed in UT, AZ, CA & 14 other states

Answered by Jonathan Potter Medicare Insurance Agent

Nikki Rowland · Answer

This depends on the Medication itself. Always make sure your medication is on the plan formulary. Insulin is capped at $35 but must also be on the formulary.  As of 2026 there is a Max Out Of Pocket of $2000 per year for all medications when on the formulary. 

If your primary concern is drug coverage, especially for expensive diabetes meds, a standalone Part D plan paired with Original Medicare might give you more flexibility and control. But if you’re also looking for extra benefits and potentially lower overall costs, a Medicare Advantage plan could be worth exploring—just be sure to scrutinize the drug coverage.  Every single person and plan needs are different. It is so important to check these things first.

Tasha Riggs · Answer

Hello, my name is Tasha Riggs with Health Markets, and today's question is: my diabetic medication is super expensive. I've heard horror stories about Part D drugs not covering what people need. Should I get a standalone Part D or get it through Medicare Advantage?

Well, I really don't know how to answer that question unless I know exactly what diabetic medicine you're taking, because I will look up your diabetic medication in the system and figure out which plan will be best for you.

Now, the Novologs and Humalog, a lot of those, especially if you're just doing the basic injectable, not the SoloStar pens but just the needle and bottle, those are super inexpensive. You can get a lot of those for just $35. They're not all that expensive. When you get the SoloStar pen, those are pre-made for you; you just click it and inject it. Those are going to be a little bit more expensive.

When you start taking, I don't want to call it designer, but a lot of the drugs that are helping Type 2 diabetes, like Ozempic and Mounjaro, and the GLP-1s, those will be expensive if they're being used for diabetic reasons. Yes, they could be very expensive. If you are using it for weight loss, it will never be covered. I don't care what insurance you have; if it's being told that it's being done for weight loss, it will not be covered. But if it's being used for diabetes and your doctor can verify that it's being used for diabetes, then yes, there are some plans that will cover it at $47.

With that said, I would really need to know what drug you have and the milligram so I can do a database search to figure out which drug plan would be best for you. Now, you asked whether you should do a standalone drug card or a Medicare Advantage. You will find Medicare Advantage plans will have a lower cost on a lot of the drugs when I run them, and it's probably because the health insurance and the drugs are all rolled into one. So they can get their loss ratio across the whole cost of the whole plan.

Where if you have a standalone drug card, it's a standalone drug card; they can't take their medicine losses and spread it out through a healthcare plan. So a lot of times, standalone drug cards are more costly premium-wise per month, and the cost of the drugs a lot of times are more expensive because there's nowhere to share the loss in the cost of the drug. So that's why you'll find Medicare Advantage plans will have, most of the time, a lower cost when you run them side by side.

Misty Bolt · Answer

IT DEPENDS ON THE MEDICATION YOU ARE TAKING. OUR JOB IS TO A MAKE SURE YOUR MEDICINE AND DOCTORS ARE COVERED

Cody Biggs · Answer

The right answer depends on your exact medications, not the plan type.

Both standalone Part D and Medicare Advantage plans can either cover your drugs well or poorly—it varies by plan formulary, dosage, and pharmacy.

For diabetes specifically, some plans cover insulin well but don’t cover newer or brand-name drugs as favorably.

Best approach: work though a broker and run your exact medication list through both options and compare total annual cost (premiums + copays). That’s how you avoid the “horror stories.”

Charles Fletcher · Answer

A knowledgeable broker, such as myself, will gather your prescription list and preferred pharmacy and help you compare standalone and Medicare Advantage drug plans. In my experience, these days, the MA plans are usually a little less expensive when compared with PDP plans all things being equal.

Answered by Charles Fletcher on April 4, 2025

Agent Licensed in WA, AZ, ID, NV & TN

Answered by Charles Fletcher Medicare Insurance Agent

Lauryn Ivey · Answer

There is not a lot of difference between a stand alone prescription drug plan and an advantage plan. Medicare regulates how they work, from deductibles, initial coverage stage, and catastrophic stage. Each carrier regulates their own formulary, which means what they cover and what tier they classify the drug at. The higher the tier the higher the cost of the drug and your copays. An agent needs to sit down with you and enter all of your drugs and show you all of your options. There is no way I can answer this question without knowing the drugs you are currently prescribed. But I strongly suggest letting an agent review your medications and explain your options; because if you drop your advantage plan then you are back to original Medicare and for Part B you will pay 20% of the bills after a deductible, as well as Part A deductibles. So it’s not just about your drug plan.

Answered by Lauryn Ivey on July 20, 2025

Broker Licensed in AL

Answered by Lauryn Ivey Medicare Insurance Agent

David Quintal · Answer

Whether an individual chooses a Part D plan or a MAPD, in each case a thorough review of the relative costs associated with each option should be done prior to enrolling into a plan. Sitting with a local and knowledgeable broker is one way to ensure that when a decision has to be made the Medicare beneficiary is aware of the plans premiums, deductibles, copays and formularies. All of these can impact prescription costs.

Answered by David Quintal on April 29, 2025

Broker Licensed in NH, AL, AZ & 14 other states

Answered by David Quintal Medicare Insurance Agent

John Hose · Answer

The best way to determine that is to find someone like me who can help you research the best options for you. 

Please contact me for more information. 

Thanks,

John Hose

Jason Wisniewski · Answer

Typically I  find Advantage plans to have better drug coverage than stand alone plans. But to recommend the right one I would need to know where you live since plans are filed by County and State and I'd need the specific names of your medications and doctors to know which plan is the best fit

Feel free to reach out for personalized help

Greg Milliser · Answer

Not having a drug covered by a Part D plan is actually very rare. Generally, there is no difference between how a stand-alone PDP plan and a Medicare Advantage plan would cover the same medication. The best thing to do would be to have a licensed agent, like myself, help you compare how the two different types of drug plans would cover your specific medication and then you could make an informed decision on which way would be best for for you.

Answered by Greg Milliser on September 9, 2025

Broker Licensed in MO, AR, IN, KS, OH & OK

Answered by Greg Milliser Medicare Insurance Agent

DeVin LeMay · Answer

Compare both options carefully — standalone Part D plans vary widely in drug coverage and costs, while Medicare Advantage plans may include drug coverage with added benefits but limited provider networks. Use the Medicare Plan Finder or reach out to a professional to check which plan best covers your specific medications.

Answered by DeVin LeMay on November 3, 2025

Agent Licensed in MA

Answered by DeVin LeMay Medicare Insurance Agent

Rob Myers · Answer

Regardless if you got with a MA or Part D standalone, it’s important to do your due diligence and have a licensed broker check what plans cover your prescription needs. For 2025 the maximum amount someone can spend of prescriptions is 2,000. Many companies already cover insulin at 35 dollar a month copays.

Answered by Rob Myers on August 18, 2025

Broker Licensed in PA

Answered by Rob Myers Medicare Insurance Agent

Steven Bleicher · Answer

Both of these options can be equally problematic, I am sorry to say! The main dilemmas are the Brand Name drugs especially those advertised on TV. You will need to do some extra homework since you face a choice of using your Part D program OR using an online US or Canadian discount website like to GoodRx, pharmacychecker, simplecare , costplusdrugs and many others. Just be sure that you use the drop-down menus on these sites to ensure the correct dosage, frequency of use and how many times a day you must take them. This will show you the least expensive copay for the Rx. Don't forget that the maximum $$ that you will spend this year on ALL your Rx's is $2,000.00, tops! Every new calendar year that will begin all over again.

Answered by Steven Bleicher on May 28, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

Kristen Skinner · Answer

Honestly it may not matter if you change to an advantage plan or a standalone Part D. They all work similar now. If you want to change make sure you call the Pharmacy and the Company you want to change to and price the drugs. Because it may not be that different.

Answered by Kristen Skinner on April 13, 2026

Broker Licensed in OK

Answered by Kristen Skinner Medicare Insurance Agent

Barbara Barnes, CMIP® · Answer

In my opinion, you are asking the wrong question. The question should not be whether Medicare Advantage or a standalone prescription drug plan is best for you to pay for your medication, the question is what plan will best cover my medication? you need to carefully look at the formulary of each plan that you’re considering to see which plan will cover most or all of your medications and at what cost. The formulary is very important because if your medication is not covered on a plan formulary the cost of that medication does not count toward the $2000 maximum out-of-pocket if you have a chronic special needs plan for diabetics in your area, I would start by looking at that plan first. A chronic special needs plan for diabetes is more likely to cover exactly what you need to treat diabetes than any other plan. In my area of the country, however, we do not have a chronic special-needs plan for diabetes. So in this area, I would be looking closely at the formularies for all available plans to see which plan would do the best at covering the medication’s that you use, keeping in mind that those medication needs may change in the future. you need to have a discussion with your doctor about any other medication‘s that they are thinking about possibly prescribing for you in the future, so that you can check to see that any plan you would purchase would also cover those medications. Once you’ve looked at which plan is best for your medication’s, you then need to look at which plan is going to be best for your medical needs. it doesn’t help you to save money on prescriptions only to spend it in lab tests and hospitalizations. It may be worthwhile to pay for some of your medications on your own so that you have better coverage if you need to go into the hospital or have major surgery or use a skilled nursing facility. these are all things that you need to consider.

Answered by Barbara Barnes, CMIP® on June 22, 2025

Agent Licensed in PA

Answered by Barbara Barnes, CMIP® Medicare Insurance Agent

Vernon Jones · Answer

I would recommend a Medicare Advantage plan. I believe you would have more flexibility through an MAPD.

Steven A James, MBA · Answer

A couple of years ago, Medicare required that insulin not have more than a $35 copay for Part D as well as Medicare Advantage Plans with Part D coverage.

In regard to other medications, in the future, Medicare will now have the ability to negotiate prescription drug pricing, so stay tuned for further developments.

Steven A James
Contact me.

Chad Watkins · Answer

The better to get my medications? I stand along Prescription Drug Plan or Medicare Advantage Plan. The answer to this question is that neither one is better than the other. All you need to do is look at the formulary to see what medications are covered. To say that your medications are covered and then also to compare not only the premium but the deductible for the plan as well as the copays for your specific drugs. And that holds true whether you're comparing a standalone prescription drug plan to another standalone prescription drug plan or to a Medicare Advantage plan.

Michael Yost · Answer

There's been some nice changes in the drug structures of Medicare, especially with diabetes medications. That's where meeting with a broker (someone like us) can help compare the drug plans in your county with the medications you take, to see what the better route to go is.

Answered by Michael Yost on April 10, 2025

Broker Licensed in OH, AL, AZ & 27 other states

Answered by Michael Yost Medicare Insurance Agent

Deb Haley · Answer

The drug formulary for each of the carriers is typically the same whether the medications are bundled in on their Medicare Advantage plan offering or on a standalone part D plan that they offer. The difference in price is that with the Medicare Advantage plan the prescription coverage is bundled in and there is no additional premium. The standalone Part D plans have a monthly premium that you pay in addition to your annual drug deductible s and copays. It would make sense to look at both options to see if there is a significant difference in price either way. The choice to go on a separate Part D plan may also be influenced by whether or not all of your medical providers are in network for a particular Medicare Advantage plan.

Answered by Deb Haley on April 11, 2025

Broker Licensed in MA, AZ, CA & 11 other states

Answered by Deb Haley Medicare Insurance Agent

Don Golding · Answer

All Part D plans, whether a "stand-alone" plan or part of an Advantage Care plan, have a specific list of covered prescription medications. That list is called the plan formulary. The key is to find a plan that covers your prescriptions. As an independent broker, we compare multiple plans to help you find the one that suits your needs.

Answered by Don Golding on May 4, 2026

Broker Licensed in TX, AL, AR & 5 other states

Answered by Don Golding Medicare Insurance Agent

Satoshi Aoki · Answer

I cannot say it is covered, and how much depends on what kind of medication you take and the Part D plan provided by the health insurance company. You should contact Medicare agents and make an appointment.

Answered by Satoshi Aoki on March 31, 2025

Agent Licensed in CA

Answered by Satoshi Aoki Medicare Insurance Agent

Heidi Delaney · Answer

It truly depends on the type of medication. Insulin is $35 for a month supply but the specific insulin you use must be on the plan formulary. Plans under specific circumstances can cover the GLP-1's. Having a good independent agent check your medications against all the plan formularies in your area is the best place to start. For now, you can ask your doctor to request it be added to the plan formulary.

Answered by Heidi Delaney on August 27, 2025

Broker Licensed in CO, AZ, KS & 5 other states

Answered by Heidi Delaney Medicare Insurance Agent

Heather Allen · Answer

It is important to sit down with a knowledgeable broker that can look at all the plans in your area and compare between Advantage plans and stand-alone plans. Having a broker that is willing to take the time is imperative and not many are willing. Some plans may need a prior auth, but again a good broker will guide you through this process.

Answered by Heather Allen on February 16, 2026

Broker Licensed in CA, DE, MI & NV

Answered by Heather Allen Medicare Insurance Agent

Kathy Olejniczak · Answer

You may encounter non covered drugs either way- that's why it's  important to to look up all you medications

Greg Giordano · Answer

For expensive diabetes medications, consider both Medicare Advantage (MA) plans with prescription drug coverage (MA-PD) and standalone Part D plans carefully. MA-PD plans bundle drug coverage with other benefits like vision, dental, and hearing, while standalone Part D plans focus solely on prescription drugs. Evaluate your specific medication needs, plan costs (premiums, deductibles, copays), and the availability of your preferred doctors and pharmacies within each plan's network.

Answered by Greg Giordano on August 1, 2025

Broker Licensed in FL, AZ, CO & 15 other states

Answered by Greg Giordano Medicare Insurance Agent

Elijah Pannell · Answer

Good morning,

   I cannot speak for other companies but as for Humana which I represent, the Part D coverage reflects the same benefits inside the Medicare Advantage plan. Which in essence, you are better off with a MAPD because you can potentially save money on the cost of the plan but also gain medical, dental and vision coverage as well. Would you like to schedule a time to speak?

Steven LaPorte · Answer

I would highly suggest a licensed Medicare advisor to assess your part D needs as well as doctors and hospitals needing to be covered pertaining to your situation. Choosing a Medicare plan can be confusing, it’s imperative that you choose an advisor that will suggest a decision to the best of your interest!

Answered by Steven LaPorte on February 23, 2026

Agent Licensed in LA, MS & TX

Answered by Steven LaPorte Medicare Insurance Agent

Nicole Hardy · Answer

Each persons coverage should be decided on an individual basis. It's important to sit with a qualified agent who understands all of the ins and outs of all Medicare plans. This will ensure you have the best coverage specific to your needs as an individual. There are many factors used to help you determine which plan(s) will work best for your needs.

Answered by Nicole Hardy on February 26, 2026

Broker Licensed in MD, AZ, PA, VA & WV

Answered by Nicole Hardy Medicare Insurance Agent

Heather Borlenghi · Answer

What do you have now for insurance coverage? A stand alone drug plan and a Medicare Advantage plan with prescription drug coverage do the same thing. One is not better than the other. I would guide you based on more information needed.

Answered by Heather Borlenghi on April 21, 2025

Agent Licensed in GA, AL, AR & 15 other states

Answered by Heather Borlenghi Medicare Insurance Agent

Mara Zia · Answer

There may be an MAPD that is more in tune to your needs. If you don't have a special enrollment period currently, then during AEP would be a great time to explore other options and compare plans to see if there is one that will be in tune with your specific needs. I hope this answer helps you.

Answered by Mara Zia on September 24, 2025

Agent Licensed in FL, AZ, CA & NC, OH, TN & TX

Answered by Mara Zia Medicare Insurance Agent

Fred Manas · Answer

Standalone Part D Plans:
Flexibility: You can generally choose any pharmacy that participates in the plan, & you're not limited to a specific provider network. 
Coverage: Part D plans cover a wide range of diabetes medications, including insulin & other oral medications. 
Formulary: While Part D plans have formularies (lists of covered drugs), they may be more flexible than some Medicare Advantage plans. 
Prior Authorization: Some Part D plans may require prior authorization for certain medications, but this is less common than in Medicare Advantage plans. 
Cost: Part D plans can vary in price, so it's important to compare premiums & copays. 
Special Considerations: The Inflation Reduction Act significantly reduced the cost of insulin, limiting out-of-pocket costs to $35 per month. If you have limited income & resources, you may be eligible for Extra Help to lower your drug costs. You can also explore patient assistance programs offered by pharmaceutical companies. 
Medicare Advantage Plans (MA-PDs):
Comprehensive Coverage: MA-PDs typically offer all the benefits of Original Medicare (Parts A and B) plus drug coverage (Part D). 
Provider Networks: MA-PDs often have specific provider networks, which may limit your choice of doctors & pharmacies. 
Prior Authorization: Some MA-PDs may require prior authorization for certain medications, even if they are on the formulary. 
Cost: MA-PDs can have lower premiums than standalone Part D plans, but copays &  deductibles may vary. 
Coordination of Care: MA-PDs may offer additional services like preventive care & chronic disease management, which can be helpful for people with diabetes. 
Special Considerations: MA-PDs may have more strict rules about which medications are covered, & it's important to check the formulary.  You may also need to obtain a prescription for any medications from your primary care physician. Some diabetes-related supplies like syringes, gauze & alcohol may also be covered by MA-PDs.

Vachik Chakhbazian · Answer

For your expensive diabetes medication, both standalone Part D and Medicare Advantage plans can offer drug coverage, but the best choice depends on your specific needs and situation.

Meghan Blankenship · Answer

The right choice depends on your medication needs, budget, and flexibility with doctors. Medicare Advantage plans often bundle drug coverage with extra benefits, while standalone Part D plans give you more freedom to pair with Original Medicare and a Medigap Supplement.

Answered by Meghan Blankenship on November 23, 2025

Broker Licensed in FL, MD & OH

Answered by Meghan Blankenship Medicare Insurance Agent

Carol Thompson · Answer

I do not recommend a stand alone pdp, Med. Adv will usually cover more. Also depending on your diabetic meds.; there are some that have a limit of $35 per month.

Mark Boone · Answer

What medication are you on? Most insulin medications are capped at $35 per month. If you are on another medication you can check with your doctor and pharmacist to see if there is a less expensive alternative. You can also see if the manufacturer can help with the cost. You can also check with the Social Security Administration to see if you qualify for low income assistance. Lastly you can have an agent shop the market for you to see if there is a better MAPD plan or stand alone PDP plan that meets your needs.

Answered by Mark Boone on August 19, 2025

Agent Licensed in MN, FL, MI & NC, OH, SC & VA

Answered by Mark Boone Medicare Insurance Agent

Suzanne Lamperti · Answer

I would go stand alone Part D. Depending on your area  Advantage plans may be restrictive and 
Not all Advantage plans have prescription drugs connected to the plan.

Todd Bostic · Answer

There are Chronic care plans specifically designed for people with diabetes so you can save money on diabetic medications.

Deborah Webster · Answer

Either way insulin are now capped at 35 per month you do need to make sure the insulin you are taking is on the formulary of the plan. That is where an agent like myself can help guide you through the plans.

Answered by Deborah Webster on April 15, 2025

Broker Licensed in Ia & SC

Answered by Deborah Webster Medicare Insurance Agent

Jennifer Kalbach · Answer

On Medicare, at this time insulin is capped at $35.00 for everyone on Medicare. Part D standalone or a Medicare Advantage Prescription Drug doesn't necessarily matter what does is are your scripts covered and if so what is the price for them (tier 1, 2, 3 , 4 ,5 6) . A good agent will run your scripts to let you know what plan pays the most but keep in mind they can change what drugs they cover at anytime. These are for profit organizations.

Answered by Jennifer Kalbach on March 17, 2026

Agent Licensed in KY

Answered by Jennifer Kalbach Medicare Insurance Agent

Toni Cormier · Answer

It is best to enter your specific medications into both the Part D and Medicare Advantage plans that you have an interest in to identify how your specific drug is covered. Then continue to review each to all of your needs not just drug coverage.

Answered by Toni Cormier on October 19, 2025

Broker Licensed in TX, CA & OK

Answered by Toni Cormier Medicare Insurance Agent

Tamela Clayton · Answer

Whether you choose a standalone Part D plan or a Medicare Advantage plan with drug coverage, the key is making sure the plan actually works for your situation.  Your agent should run your exact diabetes medications through the plan finder, check the formularies and tiers, and look at which pharmacies you use so you're not overpaying.  They should also make sure your doctors and specialists are in-network if you're considering an Advantage plan.  
There is no one 'best' route for everyone.  The key is finding a plan that covers your meds, fits your budget, and lets you keep the providers you rely on.

Ken Banks · Answer

For high-cost diabetes medication, the best choice between a standalone Part D plan and a Medicare Advantage plan depends on your specific drugs, preferred pharmacies, and overall healthcare needs. Some Medicare Advantage plans may offer lower overall costs or more integrated benefits, while standalone Part D combined with Original Medicare provides greater flexibility in choosing your doctors.

Answered by Ken Banks on October 27, 2025

Broker Licensed in GA, AL, DC & 5 other states

Answered by Ken Banks Medicare Insurance Agent

Jami Mead · Answer

There are a lot of changes for 2026 Where medications are concerned Period Your best bet is to speak with your local representative Should go through your medications the plans for diabetics and find out which plan would work better for you Period There are a lot of special plans this year for People with chronic diabetes that you may benefit from period Feel free to contact me and I'd be happy to go over that for you at no cost Period

Answered by Jami Mead on September 22, 2025

Broker Licensed in OH, FL, GA & 11 other states

Answered by Jami Mead Medicare Insurance Agent

William Scott · Answer

Check with your Medicare Advatage Broker for more detail. Yuo may qualify for additiional assistance with your prescriptions.

Adam Morillo · Answer

Great question, the $2,000 cap on the prescription plans have significantly limited the out of pocket expenses for individuals. It's best to talk to a individual broker that can easily compare a stand alone Part D plan vs a Medicare advantage to fully understand the difference and see which best suits your needs best.

Answered by Adam Morillo on July 14, 2025

Broker Licensed in FL, AK, AL & 48 other states

Answered by Adam Morillo Medicare Insurance Agent

Bud Griffin · Answer

Every Part D plan available in your zip-code will cover different diabetes medications and have different co-pays or coinsurance charges that you will be responsible for. You should compare the plans available in your zip-code to be able to make an informed decision. I offer plan comparisons free of charge and wilhout any obligation to enroll.

Answered by Bud Griffin on June 23, 2025

Broker Licensed in TX

Answered by Bud Griffin Medicare Insurance Agent

Roberto Alonso · Answer

I can not comment on what you have heard but I will take it for granted that you did hear these stories, and they make me feel bad for those that went trough any unsatisfactory experiences.

Here is what you need to know; starting in January of 2026, the Total Out Of Pocket maximum for prescription medications, including diabetic medications, is capped at $2,100 after which you are covered at 100% by your Part D plan, regardless as to what benefit model you buy it trough. 

All covered insulins under Part D are capped at $35 per month, with no deductible. This applies to either a Stand Alone PDP plans or a MA-PD. 

The cost of other diabetics drugs, and most importantly the more expensive brand name offerings that are covered under the plan's formulary, will depend on the tiering the plan calls for.   Based on what tier they fall under, you'll be responsible for the plan's deductible, copayments and coinsurance. So carefull review of the Summary of Coverages and the Formulary of any given plan is critical prior to decision making regarding plan changes.

Bruce Resnick · Answer

Although there are many more details that will affect your choice, as an agent of 10 years, I have found that many meds have very similar deductibles and co-pays either on Part D standalone or Medicare Advantage with embedded Part D. However, I have also observed that monthly premiums for standalone Part D plans frequently exceed the monthly premiums for Medicare Advantage plans.

Answered by Bruce Resnick on September 1, 2025

Broker Licensed in TX

Answered by Bruce Resnick Medicare Insurance Agent

Fran Lovelace · Answer

Your cost for the medication depends on what tier it is on with a carrier and whether the deductible applies to that medication, not necessarily if it is stand alone D or MAPD. A seasoned medicare agent can help you know if there is a carrier or plan that covers that medication better than others.

Answered by Fran Lovelace on July 31, 2025

Agent Licensed in NC, SC & VA

Answered by Fran Lovelace Medicare Insurance Agent

Tonya White · Answer

You should work with an agent and they can conduct a prescription analysis for you. Various insulin medications have reduced in cost due to the Inflation Reduction Act so I can't answer your question outright. I will also say that many Medicare Advantage plans cover many medications a lot better than stand-alone drug plans do - not always, but often. You can also go to Medicare.gov to do the analysis yourself.

Answered by Tonya White on October 26, 2025

Agent Licensed in CA, MA, MI & 5 other states

Answered by Tonya White Medicare Insurance Agent

Sonya Chandler · Answer

The affordable care act has lowered the cost for covered insulin to more than $35.00.  This cost is the same whether you're on a Part D Plan or a Medicare Advantage Plan.

Tanisha Coffey · Answer

Whether you're using Part D or if you have a Medicare Advantage plan, carrier formularies change each year. So, it's important that you always check formularies when reviewing your Medicare coverage during open enrollment. Also, enter your medications and dosages with doing the review. This will allow you to look at the projected costs for the upcoming year. This can help plan financially or to clearly see which option is the best for you to insure you can have the medication you need and less stress over how to pay for it. Meanwhile, some states offer programs that can assist with prescription drug coast for qualifying individuals. Consider looking into what your state offers and sit with a Medicare Broker who can guide you.

Answered by Tanisha Coffey on March 2, 2026

Broker Licensed in FL, CA, GA & MD, SC, TX & VA

Answered by Tanisha Coffey Medicare Insurance Agent

Ira Smith · Answer

Most Medicare Advantage Plans cover Part D with deductibles & maximum out of pocket expenses or MOOP.

Jessie Rhodes · Answer

My recommendation would be to get a Medicare Advantage Plan and one of the reason is that on Most Medicare Advantage there are no drug deductible and with a standalone drug plan they all have deductibles so I will always recommend comparing both options

Answered by Jessie Rhodes on July 26, 2025

Agent Licensed in TX, AL, AR & 24 other states

Answered by Jessie Rhodes Medicare Insurance Agent

Gene Page · Answer

Insulin caps out a $35./month. If you are on a special needs plan or receive "Extra Help" it may be less. Other medications vary by the specific plan formulary. Whether you get a MA plan or a stand alone PDP, you should be able to find comparable pricing. Be sure to review your drug list as you decide which plans will be best for you. Also, remember that most drugs have a generic version that will be less costly. Speak with your Dr. or Pharmacist about those options.

Answered by Gene Page on December 29, 2025

Broker Licensed in UT

Answered by Gene Page Medicare Insurance Agent

Jon Morton · Answer

Regardless of the type of medication, the key thing to look at is whether it is covered on a given plan, whether that is Advantage or standalone Part D. In some cases, the Advantage is adequate to cover the need. However, if a drug is an injectable administered at the doctor's office, it could be covered by Part B instead of as a drug under Part D. If it is a super expensive drug, the premium for a Supplement plan could be lower or much lower than the Part B co-insurance for that drug.

Answered by Jon Morton on January 19, 2026

Broker Licensed in NH, MA & ME

Answered by Jon Morton Medicare Insurance Agent

Mitchell Nunn · Answer

I always tell clients the same thing…. COMPARE . Take this opportunity to compare between part d plans and Medicare Advantage and see which one will cover your specific diabetes medicine better.

Kendra Siemiesz · Answer

Both stand alone part D plans and Medicare advantage plans are offered through private companies such as united healthcare, Cigna, WellCare, Humana etc. In your situation, you would be looking at what carrier will cover that medication at the most affordable cost for you and how it aligns with the rest of your healthcare needs. For example, most stand alone part D plans have a monthly premium, whereas most Medicare advantage plans often have a $0 premium and I have seen better drug coverage with advantage than most stand alone part D plans. I would suggest talking to a Medicare broker that offers both Medicare advantage and part D plans (like myself) to go over all your available options in your area and see what carrier/plan type will cover you best. There is also a program called “LIS extra help” that significantly helps reduce drug costs and eliminates drug deductibles if approved. That is something I help my clients apply for if I think they may be eligible because it’s a great program not many people know they are eligible for.

Answered by Kendra Siemiesz on November 18, 2025

Broker Licensed in FL, AL, AR & 19 other states

Answered by Kendra Siemiesz Medicare Insurance Agent

Michael Reardon · Answer

💊 Option 1: Standalone Part D (with Original Medicare)

You’d have:
	•	Original Medicare (Part A & B) for hospital and medical
	•	A standalone Part D plan for prescriptions
	•	Optionally a Medigap plan to cover deductibles and coinsurance

✅ Pros
	•	Freedom of doctors: You can see any provider that accepts Medicare.
	•	No network restrictions for medical care.
	•	Easier to switch drug plans each year if your medication changes.
	•	Predictable coverage: Part D plans follow strict CMS guidelines and formularies are published publicly.

⚠️ Cons
	•	Premiums can be higher when you add Medigap + Part D.
	•	Separate deductibles and billing systems.
	•	Part D formularies vary: Some may cover your diabetes meds well; others may not. You’ll need to compare plans carefully each fall.
	•	No extra benefits (like vision, dental, or gym) that Advantage plans often include.

⸻

🩺 Option 2: Medicare Advantage (Part C) with Drug Coverage

These plans bundle:
	•	Parts A, B, and D
	•	Often add vision, dental, hearing, and sometimes insulin or diabetic supply perks

✅ Pros
	•	One card, one plan (simplifies billing).
	•	Many plans now have $0 insulin copays or cap insulin costs at $35/month (part of the Inflation Reduction Act).
	•	Some chronic condition special needs plans (C-SNPs) are designed for people with diabetes, offering tailored benefits like nutrition, podiatry, and extra checkups.
	•	Sometimes lower or even $0 premiums.

⚠️ Cons
	•	Networks are limited — you must use doctors and pharmacies in the plan’s network.
	•	Prior authorization can delay certain supplies or new meds.
	•	Drug formularies can change, and you can only switch during open enrollment.
	•	If you travel or move often, coverage can get complicated.

⸻

💡 For Diabetes Specifically

A few tips:
	1.	Check the Insulin and GLP-1 coverage (Ozempic, Trulicity, etc.).
	•	Some Advantage plans treat them as “preferred” (low copay), others as “non-preferred” (high cost).
	•	You can look these up in the Medicare Plan Fi

Richard Allen · Answer

If you are a diabetic you should qualify for a Special Needs plan specific for your chronic condition.  Which could be for chronic conditions such as heart problems and diabetic conditions.

Adriane Williams · Answer

A part D prescription plan and a Medicare plan with prescription drug coverage is the same. Each company formulary is different. We can review if you like.

Daniel Keenan · Answer

If your goal is Drug coverage, your only requirement is that you have enrolled in Part B. You then can enroll in Part D during enrollment periods. Getting MAPD also adds extra benefits for you along with great medical benefits.

Answered by Daniel Keenan on June 8, 2025

Broker Licensed in FL

Answered by Daniel Keenan Medicare Insurance Agent

Barbara Klie · Answer

Choosing between a standalone Medicare Part D plan and getting prescription drug coverage through a Medicare Advantage plan can be a significant decision, especially if you have expensive diabetes medication. Here are some factors to consider when making your choice:
1. Coverage Options
  ◦  Standalone Part D Plan: This option is specifically designed to provide prescription drug coverage. You can choose a plan that best fits your medication needs and budget. Standalone plans can vary significantly in terms of premiums, deductibles, and copayments for different medications.
  ◦  Medicare Advantage Plan (Part C): Many Medicare Advantage plans include prescription drug coverage (MAPD). This can be convenient as it combines your medical and drug coverage into one plan. However, the formulary (list of covered drugs) may differ from standalone Part D plans.
2. Formulary and Cost
  ◦  Check the Formulary: Regardless of which option you choose, it’s crucial to check the formulary of the plan to ensure that your specific diabetes medications are covered. Some plans may have different tiers for medications, which can affect your out-of-pocket costs.
  ◦  Cost Considerations: Compare the total costs, including premiums, deductibles, and copayments for your medications under both options. Sometimes, a standalone Part D plan may offer better coverage for specific medications, while other times, a Medicare Advantage plan may be more cost-effective.
3. Network Restrictions
  ◦  Provider Networks: Medicare Advantage plans often have provider networks, which means you may need to use specific pharmacies to get the best prices on your medications. Standalone Part D plans may offer more flexibility in choosing pharmacies.
  ◦  Access to Specialists: If you have a diabetes specialist or a specific healthcare provider you prefer, check whether they are in-network with the Medicare Advantage plan you are considering.

Maureen Breslin · Answer

in 2026, no matter which plan you choose, your annual out-of-pocket costs for covered prescription drugs will be capped at $2,100.
Once you hit the $2,100 cap, you will not pay anything for covered prescriptions for the rest of the year.
If you use insulin, your out-of-pocket cost for a 1-month supply is capped at $35 in any plan.

Bobby Coates · Answer

Whether you chose standalone Part D (Original Medicare) or an Advantage Plan, it is important to remember there is no such thing as a plan that covers ALL medications. Each plan (PART D standalone or Advantage) will have its own special list (Formulary) of medications it will cover. The plan will break down the medications into tiers and that is what will determine your Co-Pay if any. I would recommend meeting with an independent agent and having them do a review to determine the best option. If you are new to Medicare you may be able to sign up now. Otherwise you will want to wait until AEP (October 15-December 7).

Answered by Bobby Coates on April 10, 2025

Agent Licensed in TX, AL, AZ & 21 other states

Answered by Bobby Coates Medicare Insurance Agent

Eva Peterson · Answer

Different carriers cover differently so you should review your meds with a broker. This is at no cost to you ever and I’m happy to work with you to help you make the right choice. Contact me, Eva Peterson. Looking forward to speaking with you!

Answered by Eva Peterson on April 14, 2025

Agent Licensed in CA, FL & NV

Answered by Eva Peterson Medicare Insurance Agent

Jennise Housel · Answer

If your diabetes meds are expensive, you’ll want to compare standalone Part D plans and Medicare Advantage (MA) plans with drug coverage, because not all plans cover the same drugs or offer them at the same cost. 

Some MA plans include better drug formularies or insulin savings programs, but others may be restrictive. 

A standalone Part D plan gives you more flexibility if you’re staying on Original Medicare and want to choose the drug plan that best covers your specific medications.

My diabetes medication is super expensive, and I've heard horror stories about Part D not covering what people need. Should I go standalone Part D or get it through a Medicare Advantage plan?

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My diabetes medication is super expensive, and I've heard horror stories about Part D not covering what people need. Should I go standalone Part D or get it through a Medicare Advantage plan?

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