Tuesday, July 7, 2026Vol. XII · No. 47

The Health Almanac

Field Reports · Enrollment Wires · Beneficiary Tools

Tool · Plan Finder

The Medicare Plan Finder, Used the Way It Should Be

The official Plan Finder is the only tool that surfaces your true annual out-of-pocket cost by plan. Here is how to run it so the results reflect what you'll actually pay.

Coverage Desk · Updated this quarter · 6 min read

Medicare's Plan Finder at medicare.gov/plan-compare is the only source of truth for what a specific Part D or Medicare Advantage plan will cost you next year. Carrier marketing materials show premium and headline copays; Plan Finder projects total annual out-of-pocket cost using your drugs, your pharmacies, and the plan's formulary.

Before you start

  • Your Medicare number.
  • An accurate list of every prescription with dosage, quantity and refill cadence.
  • Your ZIP code and the two or three pharmacies you actually use.
  • Any preferred-provider or hospital constraints (for Medicare Advantage comparisons).

Running the comparison

  1. Choose "Drug plan (Part D)" or "Medicare Advantage plan (Part C)" depending on what you want to compare.
  2. Sign in with your Medicare account for saved drugs, or enter each medication manually.
  3. Select mail order and each retail pharmacy you'd use.
  4. Sort by Lowest drug + premium cost. This is total projected annual out-of-pocket, the number that actually matters.
  5. Open the top three plans. On each plan's page, verify every drug is on the formulary at a tier you can afford, with no utilization management surprises.
  6. Check the Star Rating, and for MA plans, confirm your providers are in-network on the carrier's own site (Plan Finder network data can lag).

What to look for beyond the headline cost

  • Utilization management flags — PA (prior authorization), ST (step therapy), QL (quantity limits). Any drug you take regularly should be as unencumbered as possible.
  • Preferred pharmacy pricing. The same plan often has meaningfully different cost-sharing at a preferred vs. standard pharmacy.
  • Mail-order savings. Maintenance drugs are typically cheaper by mail, but only if the plan's PBM has a mail contract you'd actually use.
  • The Medicare Prescription Payment Plan. All Part D plans must offer it starting in 2025 — election is done through the plan, not through Plan Finder.

Re-run it every year

Plans change formularies, tiers, preferred pharmacies and premiums every January. A plan that was optimal last year can be materially worse this year. Re-run Plan Finder during the Annual Election Period (October 15 – December 7) even if you're satisfied with your current plan.

When to bring in a human

If you have a complex drug list, a rare condition, or dual Medicare + Medicaid eligibility, the free counselors at your State Health Insurance Assistance Program (SHIP) are unpaid, unbiased, and trained specifically on this tool. Find yours at shiphelp.org.