In short
- The 2027 limits apply to both: a drug deductible of no more than $700 and a $2,400 yearly cap on covered drug costs.
- Nebraska has 9 standalone Part D plans from 5 companies for 2027, down from 11 in 2026. The lowest premium is $5.30 a month.
- Every Lancaster County Medicare Advantage plan with drug coverage has a drug deductible for 2027, from $250 to $700.
- In a Medicare Advantage HMO or PPO, you cannot add a separate Part D plan.
- Choose the plan by running your exact medications and pharmacy, not by the premium.
Standalone Part D plan vs Medicare Advantage drug coverage at a glance
| Feature | Standalone Part D plan | Medicare Advantage drug coverage |
|---|---|---|
| Works with | Original Medicare, with or without a Medigap policy | Built into a Medicare Advantage plan |
| Nebraska choices, 2027 | 9 plans from 5 companies, statewide | 24 standard plans with drugs statewide; 22 in Lancaster County |
| Premium | Separate monthly premium; Nebraska's lowest is $5.30 in 2027 | Bundled into the plan premium; national average drug portion $7 in 2027 |
| Drug deductible | No more than $615 in 2026 and $700 in 2027 | Same limits; all 22 Lancaster County plans have one in 2027 |
| Yearly cap on covered drug costs | $2,100 in 2026; $2,400 in 2027 | $2,100 in 2026; $2,400 in 2027 |
| Insulin | No more than $35 for a month's supply, no deductible | No more than $35 for a month's supply, no deductible |
| Doctors and hospitals | Any provider that takes Medicare | The Medicare Advantage plan's network rules apply |
| Pharmacy network | Yes; preferred pharmacies may cost less | Yes; preferred pharmacies may cost less |
| When you can switch | Annual Enrollment Period, October 15 to December 7 | Annual Enrollment Period, plus one change from January 1 to March 31 |
| Part D income surcharge (IRMAA) | Applies above $109,000 single or $218,000 joint (2026, based on 2024 income) | Applies the same way |
The short answer
If you have or want Original Medicare with a Medigap policy, a standalone Part D plan is how you get drug coverage. If you choose Medicare Advantage, its built-in drug coverage is usually the way to go. Either way, pick the specific plan by running your medications and pharmacy through every option.
There are two ways to get Medicare drug coverage. You can add a standalone Part D plan to Original Medicare, or you can get drug coverage built into a Medicare Advantage plan. The drug rules are the same either way. What changes is everything that comes with them.
What is the difference between standalone Part D and Medicare Advantage drug coverage?
A standalone Part D plan covers only prescriptions and works alongside Original Medicare, with or without a Medigap policy. Medicare Advantage drug coverage is part of an all-in-one plan that also replaces Original Medicare for your doctor and hospital care.
That makes this less a drug decision than a coverage decision. If you want to see any provider that takes Medicare, you need Original Medicare, and that means a standalone drug plan. If you have chosen Medicare Advantage, drug coverage usually comes with it, and you live with its network. Our Medigap vs Medicare Advantage comparison covers that bigger choice.
Are the 2026 and 2027 drug cost rules the same for both?
Yes. These federal limits apply to standalone drug plans and Medicare Advantage drug coverage alike.
| Rule | 2026 | 2027 |
|---|---|---|
| Highest allowed drug deductible | $615 | $700 |
| Yearly cap on covered drug costs | $2,100 | $2,400 |
| Cost after you hit the cap | Nothing for covered drugs | Nothing for covered drugs |
| Insulin, per month's supply | No more than $35 | No more than $35 |
| Recommended adult vaccines (like shingles) | No cost | No cost |
| Late penalty base premium | $38.99 | $41.33 |
Both kinds of plans also offer the Medicare Prescription Payment Plan, which spreads your drug costs across the year. Extra Help works with both if you qualify. And both carry the Part D income surcharge, called IRMAA, if your income is high enough. The cap itself is explained on our Part D out-of-pocket cap page.
How do premiums compare for 2027?
Medicare Advantage plans usually fold the drug premium into a lower combined premium. CMS projects the average Part D portion of a Medicare Advantage premium falls from $11.32 in 2026 to $7 in 2027. The average standalone drug plan premium rises slightly, from $35.09 to about $36.
Nebraska's standalone market is shrinking. CMS counts 9 standalone drug plans for 2027, down from 11, and two plans leave the state. The lowest premium is $5.30 a month, but the range runs to more than $200. A federal program that held down standalone premiums in 2026 ends this year, which CMS says returns Part D to "traditional market conditions" in 2027.
On the Medicare Advantage side, 16 of the 22 Lancaster County plans with drug coverage have a $0 monthly plan premium for 2027, though you still pay your Part B premium ($202.90 in 2026). Premiums, drug lists and benefits vary by county and change every year. Our Part D in 2027 update has more.
Do Medicare Advantage plans have drug deductibles now?
In Lancaster County, all of them do for 2027. CMS plan data shows every one of the 22 standard Medicare Advantage plans with drug coverage has a drug deductible, ranging from $250 to the full $700. Each one also covers at least one drug tier before the deductible.
Who is a standalone Part D plan a good fit for?
A standalone plan fits anyone on Original Medicare. That includes most people with a Medigap policy, since Medigap does not cover prescriptions.
- You want to see any doctor or hospital that accepts Medicare.
- You split time between states and do not want network limits.
- You want to change your drug plan each fall without touching your medical coverage.
Who is Medicare Advantage drug coverage a good fit for?
It fits people who have already decided Medicare Advantage is right for their medical care, and whose doctors are in the plan's network.
- You like one card and one company for medical and drug coverage.
- A low combined premium matters to your budget.
- Your medications land on low tiers in a plan whose network includes your doctors.
What mistakes do people make with drug coverage?
The biggest mistake is choosing by premium. A plan with a low premium can cost hundreds more if your medication sits on a high tier or counts toward a $700 deductible.
Other common mistakes:
- Skipping Part D because you take nothing today. The late enrollment penalty lasts as long as you have Part D. Twenty months without coverage adds 20% of $41.33, or about $8.30 a month, for as long as you have Part D.
- Ignoring the pharmacy. Medicare says costs can be lower at a preferred pharmacy. The same plan can price the same drug differently at two stores.
- Assuming last year's plan still fits. Read your Annual Notice of Change. Drug lists, tiers and deductibles change every January.
- Using the Medicare Advantage Open Enrollment Period the wrong way. From January 1 to March 31, you can switch Medicare Advantage plans or drop to Original Medicare and add a drug plan. You cannot switch from one standalone drug plan to another during that window.
Our post on why every review starts with medications walks through how we run a drug list.
Where can you compare drug plans yourself?
Medicare.gov's Plan Finder prices your exact drugs at your pharmacy for every plan in your ZIP code. You can also call 1-800-MEDICARE (1-800-633-4227), available 24 hours a day, 7 days a week (TTY 1-877-486-2048). Nebraska SHIP (formerly SHIIP) offers unbiased counseling at 1-800-234-7119. See our page on SHIP and local help.
If you would like your medication list run against every plan in your county, talk to me. My help costs you nothing.
Frequently asked questions
Not with a Medicare Advantage HMO or PPO. Medicare says if you join one of those plans without drug coverage, you cannot join a separate Medicare drug plan. Only certain plan types, such as Medical Savings Account plans and some Private Fee-for-Service plans, allow a separate drug plan. If you want a standalone Part D plan, you generally need Original Medicare.
Yes. The out-of-pocket cap on covered Part D drugs applies to standalone drug plans and to Medicare Advantage plans with drug coverage alike. It is $2,100 in 2026 and $2,400 in 2027. Once your costs, plus certain payments made for you such as Extra Help, reach the cap, you pay nothing more for covered Part D drugs for the rest of the year.
CMS says the lowest standalone Part D premium in Nebraska for 2027 is $5.30 a month, among 9 plans. KFF reports no standalone drug plans nationally will have a zero premium for people without Extra Help in 2027. The cheapest premium is not always the cheapest plan, since deductibles, drug tiers and pharmacy pricing can cost far more than the premium difference.
It is usually wise to have it. If you go 63 or more days in a row without Part D or other creditable drug coverage after your Initial Enrollment Period, you may owe a late enrollment penalty for as long as you have Part D. The penalty is 1% of the national base premium, $41.33 in 2027, for each full month without coverage.
No. Medigap policies sold today do not include drug coverage. The Nebraska Department of Insurance notes that a separate Part D plan may be needed. If you have an older Medigap policy that was sold with drug coverage, you can keep it, but you cannot have drug coverage in both that policy and a Part D plan.
Each plan has its own formulary, or list of covered drugs, and its own tiers. If a drug you take is not covered, you or your prescriber can ask the plan for an exception, or you can look for a plan that covers it during the Annual Enrollment Period, October 15 to December 7, 2026. Check every medication, dose and pharmacy before you enroll.
Sources
- Medicare.gov: Medicare & You 2027 (CMS Product No. 10050) (opens in a new tab)
- CMS: CY 2027 Medicare Advantage and Part D Rate Announcement (opens in a new tab)
- CMS: 2027 Medicare Advantage and Part D premiums and plan landscape (Sept. 28, 2026) (opens in a new tab)
- CMS: Medicare Open Enrollment in Nebraska, 2027 state fact sheets (opens in a new tab)
- CMS: CY 2027 Medicare Advantage and Part D landscape files (opens in a new tab)
- KFF: Part D stand-alone drug plan premiums for 2027 (Oct. 2, 2026) (opens in a new tab)
- Medicare.gov: Insulin coverage (opens in a new tab)
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. 1-800-MEDICARE (1-800-633-4227) is available 24 hours a day, 7 days a week. TTY users can call 1-877-486-2048.
