Medicare has rules. Being part of the government: Yup, Lots and lots of rules. As healthcare agents, we especially need to follow these rules in order to stay in Medicare’s good books. This will limit the information I would otherwise provide in this video and if I seem vague on points, or don’t mention any specific carriers by name, you’ll understand why.
There is something else that is important to know. As of 2026 very few prescription drug plans pay healthcare agents, such as we are, a commission anymore as they did in the past. With new regulations that have been imposed on them by Medicare, drug plan carriers came to the belief that their margins were too tight to pay agents. As a result, most healthcare agents have chosen to leave drug coverage entirely to the client to figure out for themselves. For many people though, especially those taking high-cost drugs, or with many prescriptions, this is where some people need the assistance of an experienced healthcare agent the most.
With my agency, ItsThatTime, myself and my agents therefore see helping clients with their drug plans as a service. If you need help, or advice, or a quote, we are here to offer this to you, even without a paid commission, as an important service. And before anyone offers, no, we cannot take payment of any kind directly from clients. Not even homemade cookies. That is strictly against Medicare’s rules.
So, if we do a good job, send us a testimonial, and send any friends you have joining Medicare our way, as your thanks.
That said, drug coverage can come in a few different forms. First as an included part of Medicare Advantage plans. But if you are viewing this video then the chances are you are going with Original Medicare and a Medigap supplement instead. Second, some people have VA coverage and can get their prescriptions through the VA. But for most people who are choosing Original Medicare, you will need what is called a stand-alone prescription drug plan.
There are 4-5 carriers that offer these drug plans with premiums ranging from very little to over $100 a month. The difference in cost comes down to the drugs each plan covers, with more expensive plans having a larger number of drugs they cover which is called their formulary. The more expensive plans also often cover the deductible which can be up to $615 in 2026. The less costly plans don’t cover the deductible, however they usually, but not with all plans, exempt Tier 1 and 2 generic drugs from the deductible.
For the majority of people, the less expensive plans work just fine but for those with more expensive drugs it will be important to know which drug plans cover your drugs the best and with the lowest copayment cost.
We can help research this as a service to you. You can also run your drugs yourself by going to Medicare.gov, and putting in your drugs you take, and the dosages. If you are on simple generic drugs most drug plans may well formulate them the same as Tier 1 and Tier 2 drugs. If this is the case you will likely pick your plan based upon the lowest premium cost.
Another factor could be which pharmacies are preferred by a plan, which leads to a smaller co-payment. For instance, if you use Walgreens, Walgreens could be a preferred pharmacy with some drug plans but not others. Medicare.gov will also show you which plans your pharmacy is preferred with.
On the Medicare.gov site you will see all the plans that are offered, how much the monthly premium will be and an estimate of your drug costs for each plan based upon the drugs you entered, and their tiers with each plan. The bottom line is you will be able to gauge which plan fits best for you based on overall cost which includes the monthly premiums combined with the drug co-payments for the drugs you take.
Of great importance to some people will be whether all their drugs are even in a plan’s formulary. If a drug is not, and you need to take that drug, you can apply for a formulary exception, with your doctor’s help, to have it brought into formulary. There is no guarantee on success. Experimental drugs and compound drugs are of particular challenge.
You will also be able to change your drug plan each year during Annual Enrollment Period. Each year you should also do a review, especially if you take higher tiered drugs, as plans can change their drug formulary from year to year. Annual premiums can also change dramatically from one year to the next.
