Prescription drug costs are one of the biggest expenses in retirement. Matt Vallier helps South Florida residents compare Part D plans from multiple carriers to find the coverage that keeps your medications affordable all year long.
Medicare Part D is the prescription drug benefit available to everyone enrolled in Medicare. It was added to the Medicare program in 2006 and is offered through private insurance companies approved by Medicare. Part D covers a wide range of prescription medications, including brand-name drugs, generic drugs, specialty medications, and some vaccines not covered under Part B.
Part D plans are available in two forms. Standalone Prescription Drug Plans (PDPs) are designed for people who have Original Medicare (Parts A and B) with or without a Medigap supplement. Medicare Advantage Prescription Drug Plans (MA-PDs) bundle prescription drug coverage into a Medicare Advantage plan. If you have a Medicare Advantage plan that includes drug coverage, you do not need a separate standalone Part D plan.
Every Part D plan maintains a formulary, which is the list of medications the plan covers. Formularies vary significantly between plans, which is why comparing plans based on your specific medications is critical. A drug that costs $10 on one plan could cost $50 or more on another, or it might not be covered at all. The plan that works perfectly for your neighbor may be entirely wrong for you based on which medications you take.
In South Florida, Medicare beneficiaries typically have access to 20 or more standalone Part D plans in any given year, plus the drug coverage built into dozens of Medicare Advantage plans. That variety is good for competition and pricing, but it makes choosing a plan without professional help a time-consuming and error-prone process.
Part D plans organize their covered medications into tiers, and the tier a drug is placed on determines how much you pay. While the exact structure varies by plan, most Part D formularies use a similar tiered system.
Tier 1 -- Preferred Generic: These are the lowest-cost medications on the formulary. They are generic drugs that the plan has identified as preferred options, often costing just a few dollars per prescription. If a generic version of your medication exists and is on Tier 1, this is where you will see the best pricing.
Tier 2 -- Generic: Other generic medications that are covered but may cost slightly more than Tier 1 drugs. Copays are still relatively low, typically in the $5 to $20 range depending on the plan.
Tier 3 -- Preferred Brand: Brand-name drugs that the plan has negotiated favorable pricing on. These cost more than generics but less than non-preferred brands. Expect copays in the $30 to $50 range, though this varies by plan.
Tier 4 -- Non-Preferred Brand: Brand-name drugs that are not on the preferred list. Copays are higher, often in the $80 to $100+ range. If you take a Tier 4 medication, it is worth checking whether another plan places that drug on a lower tier.
Tier 5 -- Specialty: High-cost medications used to treat complex conditions like cancer, rheumatoid arthritis, hepatitis C, and multiple sclerosis. Specialty drugs can cost hundreds or even thousands of dollars per month, and cost-sharing is typically a percentage of the drug's price (coinsurance) rather than a flat copay.
Matt enters all of your medications into a plan comparison tool that shows you the total annual cost under each available Part D plan, not just the monthly premium. This total cost analysis includes premiums, deductibles, copays for each drug, and any costs you would face in the coverage gap.
The Part D coverage gap, commonly called the donut hole, has been one of the most confusing and frustrating aspects of Medicare drug coverage since Part D was created. Here is how it works in plain terms.
Part D coverage has four phases. In the deductible phase, you pay the full cost of your drugs until you meet your plan's annual deductible (if it has one). Not all plans have a deductible, and some waive it for generic drugs. In the initial coverage phase, you pay your normal copays or coinsurance while the plan pays its share. This continues until the combined amount you and the plan have spent on covered drugs reaches a set threshold.
Once that threshold is reached, you enter the coverage gap. Historically, this meant paying a much higher percentage of your drug costs out of pocket. However, the Inflation Reduction Act has brought major relief. Starting in 2025, Part D out-of-pocket costs are capped at $2,000 per year. Once you reach $2,000 in true out-of-pocket spending, you move into catastrophic coverage where you pay nothing for the remainder of the year.
This $2,000 cap is a significant change that benefits Medicare beneficiaries who take expensive medications. Before this cap, some seniors faced thousands of dollars in out-of-pocket drug costs. The new cap also allows you to spread your costs over the year through the Medicare Prescription Payment Plan, which lets you pay in monthly installments rather than all at once at the pharmacy counter.
Understanding how these phases apply to your specific medications is critical when choosing a Part D plan. Two plans with the same monthly premium can have dramatically different total annual costs depending on how they handle your drugs in each phase. This is exactly the kind of analysis Matt performs for every client.
If you have limited income and resources, you may qualify for Extra Help, also known as the Low-Income Subsidy (LIS). This federal program helps pay Part D premiums, deductibles, and copays, reducing your prescription drug costs to just a few dollars per medication.
Extra Help is available to Medicare beneficiaries whose annual income falls below 150% of the federal poverty level and whose assets are below certain thresholds (not counting your home, car, personal belongings, or burial plots). In Florida, hundreds of thousands of Medicare beneficiaries qualify for Extra Help but have never applied.
If you qualify for full Extra Help, you pay no Part D premium (as long as you choose a benchmark plan), no deductible, and just $1.55 to $4.50 per prescription in 2025. If you qualify for partial Extra Help, you receive a sliding-scale subsidy that reduces your premium and lowers your copays.
People who receive Supplemental Security Income (SSI), full Medicaid, or participate in a Medicare Savings Program (QMB, SLMB, or QI) are automatically eligible for Extra Help and do not need to apply separately. For everyone else, the application can be submitted through the Social Security Administration.
Matt can screen you for Extra Help eligibility as part of your Part D consultation. If you qualify, he will make sure you are enrolled in a plan that maximizes the benefit and keeps your out-of-pocket costs as low as possible.
Choosing a Part D plan based on the monthly premium alone is one of the most common and costly mistakes Medicare beneficiaries make. A plan with a $0 premium can end up costing you hundreds more per year than a plan with a $30 premium if the cheaper plan places your medications on higher tiers or has a higher deductible.
Here is what Matt evaluates when comparing Part D plans for you:
Matt runs this analysis using your complete medication list and presents you with a clear comparison showing the total annual cost under each available plan. No guesswork, no assumptions.
The Annual Enrollment Period (AEP) for Medicare Part D runs from October 15 through December 7 each year. This is the window when you can enroll in a Part D plan for the first time (if you missed your initial enrollment), switch to a different Part D plan, or drop Part D coverage entirely (though this is rarely advisable).
Reviewing your Part D plan every year during AEP is one of the smartest things you can do as a Medicare beneficiary. Here is why: Part D plans change their formularies, tiers, copays, premiums, and pharmacy networks every year. A plan that covered your medications at low cost this year may move one of your drugs to a higher tier or drop it from the formulary entirely next year. Without an annual review, you could end up paying significantly more than necessary.
In addition to AEP, you can enroll in Part D during your Initial Enrollment Period (the seven-month window around your 65th birthday) or during a Special Enrollment Period triggered by events like losing employer drug coverage, moving to a new service area, or qualifying for Extra Help.
Important: If you do not enroll in Part D when you are first eligible and you do not have other creditable drug coverage (coverage at least as good as Part D), you will face a late enrollment penalty. The penalty is calculated based on how many months you went without coverage and is added to your Part D premium for as long as you have Medicare. It is a permanent surcharge that can add up to hundreds of dollars per year over time.
Matt recommends scheduling your annual Part D review in early October, before AEP opens, so you have time to compare plans thoroughly and make an informed decision before the December 7 deadline.
Florida's large Medicare population and competitive insurance market create both challenges and opportunities when it comes to prescription drug coverage. With more than 4.7 million Medicare beneficiaries in the state, Florida is one of the largest Part D markets in the country, which means insurers offer a wide variety of plans with competitive pricing.
However, Florida also has some of the highest prescription drug utilization rates in the nation. The state's senior population takes an average of four to five prescription medications per person, and many take medications for multiple chronic conditions simultaneously. Diabetes medications, blood pressure drugs, cholesterol-lowering statins, and blood thinners are among the most commonly prescribed drugs for Florida's Medicare population.
The cost of prescription drugs continues to rise, but recent federal legislation has introduced meaningful protections. The Inflation Reduction Act requires Medicare to negotiate prices on select high-cost drugs, caps insulin at $35 per month for Medicare beneficiaries, and introduced the $2,000 annual out-of-pocket cap on Part D spending. These changes are especially impactful in Florida, where a significant percentage of the Medicare population relies on insulin and other high-cost maintenance medications.
In Broward and Palm Beach counties, Medicare beneficiaries typically have access to 25 or more Part D plan options each year. The difference in annual cost between the best plan for your medications and the worst can be $1,000 or more. That is why a personalized comparison based on your exact medication list is essential, and it is exactly what Matt provides at no cost to you.
Choosing the right Part D plan requires a detailed analysis of your medications, your pharmacy, and the specific cost structure of every available plan. It is not something you can do accurately by looking at a plan's marketing brochure or comparing premiums alone. Matt Vallier does this analysis for every client, every year.
As an independent agent, Matt is not affiliated with any single carrier. He has access to all Part D plans available in your zip code and compares them objectively based on your total annual cost. He checks formulary coverage for every one of your medications, verifies your pharmacy is in-network, identifies any prior authorization requirements, and presents you with a clear recommendation backed by data.
His service is completely free to you. Agent commissions are paid by the insurance companies, so there is no fee, no obligation, and no pressure. And unlike a website or a call center, Matt is a local agent based in Coral Springs who provides personalized service and year-round support to clients throughout Broward County, Palm Beach County, and South Florida.
Whether you are enrolling in Part D for the first time, reviewing your plan during AEP, or dealing with a coverage issue mid-year, Matt is one phone call away.