Whether seniors choose Medicare Advantage plans or Original Medicare, prescription drug coverage is undergoing a major structural shift heading into 2027.
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Florida seniors will need to navigate new federal spending caps, higher standard deductibles, and tighter plan formularies that could drastically change their out-of-pocket healthcare costs as they re-enroll.
With these changes, experts urge the 5.3 million Floridians enrolled in Medicare to carefully review the Annual Notice of Change their plan sent in September.
Many Part D plans and Medicare Advantage plans with drug coverage are expected to adjust coverage in ways that directly affect medication costs and monthly premiums.
“Anyone in Florida who has a Part D drug plan is going to see increased costs,” said Evan Tunis, president of E&M Global Insurance, a Hollywood Medicare brokerage firm. “You should review your prescription drug plan and don’t think just because it worked last year that it’s going to be the same as this year. Look at it again.”
While the number of standalone Part D drug plans will drop about 13% nationwide, that won’t happen in Florida. The number of standalone Part D plans available statewide will actually increase by one in 2027, bringing the total to 11. Of those, Humana offers three, while UnitedHealth Group (AARP), GuideWell (Florida Blue), and Centene (Wellcare) each offer two. About half of Florida’s standalone plans are enhanced, meaning they cover a larger percentage of total prescription costs on average than basic plans.
Medicare experts note that, nationwide, no $0-premium standalone Part D plans will be available in 2027 for beneficiaries with limited resources who are not enrolled in the Extra Help program.
Enrollment takes place from Oct. 15 to Dec. 7.
Part D premiums will vary widely in 2027
In Florida, Centene will offer the lowest premium for standalone coverage in 2027. Premiums for Centene’s two Wellcare plans in Florida will be as low as $5.30 for the Value Script plan or $7.30 for the Classic plan. Take note, though: Centene designated its standalone Part D plans as non-commissionable, so many brokers have stopped recommending or selling them.
“Many enrollees will see only modest premium increases” in their current standalone Part D plan, “but others will see big jumps,” Tunis said.
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AARP-branded standalone Part D plans from UnitedHealthcare will see significant premium increases in Florida, with monthly rates climbing as high as $184.10 for its enhanced plan, according to the Centers for Medicare & Medicaid Services.
Louise Norris, a health policy analyst for medicareresources.org, advises seniors to consider overall costs rather than price alone, as a plan with a lower premium may feature higher cost-sharing for medications or cover fewer drugs overall.
The 2022 Inflation Reduction Act capped total Part D out-of-pocket spending at $2,400 in 2027, up from $2,100 in 2026 and a major shift from 2024, when no cap existed. Once seniors reach Medicare’s new $2,400 out-of-pocket threshold, their covered prescriptions are 100% free for the rest of the year. However, reaching that cap still requires substantial upfront spending — and not every drug counts toward it.
Norris warned that if an insurer drops a medication from its covered drug list (formulary) for 2027, the plan holder could be left paying full retail price. Some plans are also adding utilization requirements, such as prior authorization.
In addition, the maximum standard drug deductible rises to $700 in 2027.
Seniors must pay this full amount out of pocket at the pharmacy before the plan begins sharing costs. In the year ahead, plans are moving expensive brand-name drugs into higher tiers requiring 20% to 33% coinsurance rather than flat $45 copays, causing enrollees to hit that $700 deductible and $2,400 cap much faster in the early months of the year.
Medicare Advantage drug coverage will be slimmer
In Broward and Palm Beach counties, only 74 Medicare Advantage plans in total offer Part D drug coverage, representing about 34% of all plans in those counties in 2027, according to the CMS 2027 Landscape.
When deciding whether to stay on an existing Medicare Advantage plan or switch, consider whether medications will continue to be covered the same way. A plan with a $0 monthly premium might cost more overall if your specific medications move to higher-cost tiers or become subject to a new drug deductible.
“Do not just look at your medical network — check the drug formulary, cost tiers, and pharmacy network changes,” Norris said.
In South Florida, Beatrice Scafidi, SHINE liaison for the Area Agency on Aging of Palm Beach/Treasure Coast, has noticed Medicare Advantage plans moving several drugs to different tiers, “so people have to keep an eye on that too.”
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Some prescription medications could become less costly
Under the Inflation Reduction Act, 15 additional brand-name drugs will feature lower negotiated prices (including popular treatments for diabetes, heart conditions, and cancer). This is expected to lower out-of-pocket costs for Medicare enrollees who rely on them, building on the initial 10 high-cost drugs whose negotiated prices took effect previously.
While the base cost of these 15 additional drugs will drop in 2027, actual savings will depend on how a specific Medicare Advantage plan places each drug within its tier structure.
“If you look at that list of drugs, they’re pretty expensive even with the negotiated rates,” Norris said.
Original Medicare with Part D plans offers more options
In 2027, 11 Part D plans are available in every Florida county, up from 10 in 2026.
As with Medicare Advantage plans, the $2,400 out-of-pocket drug spending cap protects Original Medicare seniors from runaway costs on expensive medications. However, in 2027, the standard deductible jumps to $700 (up from $615 in 2026), and a temporary federal subsidy program ends, pushing monthly Part D premiums higher for nearly half of standalone plan holders.
Standalone plan premiums vary wildly — some increasing by 30% to 50% or more depending on the specific plan. Florida seniors keeping their current standalone plan on “auto-pilot” could face significant sticker shock.
“The thing about standalone Part D plans is there is just a ton of variation from one plan to another in terms of the premium,” Norris said. “I think most standalone Part D plans will have sort of a premium increase.”
Norris emphasizes that choosing a Part D plan for 2027 will require more careful comparison.
“You need to look at your specific drugs and see how they’re covered on each plan, because you don’t want to just pick the cheapest plan and then find out that it doesn’t have your drugs covered in its formulary or it puts drugs you take in the highest tier, and your out-of-pocket costs are higher,” she said.
Norris recommends using the official Medicare.gov comparison tool: “Enter the drugs you take, and it shows plans in your area with total costs, including premiums and your out-of-pocket costs.”
She also advises checking costs across multiple local pharmacies: “They give you an option in there to put in multiple pharmacies because even on the same drug plan the cost may differ,” she said.
Seniors facing high upfront prescription costs early in the year can opt into the Medicare Prescription Payment Plan, which spreads out-of-pocket costs into manageable monthly payments throughout the calendar year.
“If you are on a really expensive medication where you might have to spend a whole $2,400 in just the first few months of the year, you can reach out to your plan and get yourself set up on a payment plan that allows you to spread that cost out equally over the whole year,” Norris said.
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What else to know
With the increasing popularity of GLP-1 medications for weight loss, a federal initiative available in 2027 will allow eligible Medicare Advantage and standalone Part D enrollees who meet clinical criteria for obesity or chronic weight management to access drugs like Wegovy or Zepbound for a flat copay of $50 per month. This coverage operates independently of a beneficiary’s standard Part D plan formulary.
“These weight loss drugs are all the rage,” said Hollywood insurance broker Ricky Rash with Health Options USA. “But in order for the client to save a lot of money, they’ve got to get a proper prescription from their physician.”
Rash said seniors should get help navigating Open Enrollment if needed, noting Medicare in 2027 is far from “business as usual”
South Florida Sun Sentinel health reporter Cindy Goodman can be reached at [email protected].
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Medicare open enrollment deadlines
- Oct. 15 to Dec. 7, 2026: You can switch from Medicare to Medicare Advantage or do the reverse and return to Original Medicare. You can also switch Medicare Advantage plans or change prescription drug plans, known as Part D. If you did not enroll in Part D plans when you were first eligible for Medicare, you can do so during this period.
- Jan. 1, 2027: Changes made during fall enrollment will take effect.
- Jan. 1 to Mar. 31, 2027: If you have a Medicare Advantage plan, you can change to a different plan or switch to Original Medicare (and join a separate Medicare drug plan) once during this time. Any changes you make will take effect on the first day of the month following the plan’s receipt of your request.
- Exceptions: You can make changes to your Medicare Advantage and Medicare prescription drug coverage anytime in 2027 if you have special circumstances, such as if you move, are no longer eligible for Medicaid, your plan goes out of business, or you lose coverage from your employer.
- 5-Star Special Enrollment: If a 5-star rated Medicare Advantage plan is available in your area, you can switch to it from Dec. 8, 2026, through Nov. 30, 2027. You can make this switch only once during this time period. Coverage typically begins the first day of the month following the month the plan receives your enrollment request. Use the Medicare Plan Finder on medicare.gov to find plans with a 5-star rating in your area.