Florida Blue Medicare Part D: 2026 Costs, Coverage, and Enrollment

Florida Blue sells Medicare Part D prescription drug coverage to Florida residents two ways: as a standalone BlueMedicare drug plan that layers onto Original Medicare, or bundled inside a Medicare Advantage plan that already includes hospital and medical benefits. Both run under the federal Part D rules that changed significantly for 2026, including a new $2,100 annual cap on what you pay out of pocket for covered drugs.¹

Two Ways to Get Drug Coverage From Florida Blue

The first option is a standalone Prescription Drug Plan, or PDP. It pairs with Original Medicare, or with a Medigap policy, and simply adds drug coverage on top of the doctors and hospitals you already use.

The second is a Medicare Advantage plan that includes drug coverage, sometimes called an MA-PD. These plans fold hospital, medical, and prescription benefits into one Florida Blue plan. If you’re on a Medicare Advantage plan with drug coverage, you don’t need a separate standalone PDP, and enrolling in one will generally disenroll you from the Advantage plan.²

Florida Blue markets its standalone coverage under the BlueMedicare brand and has historically offered two main options: one with a lower deductible or none at all paired with a higher monthly premium, and one with a lower premium but a higher deductible. Specific plan names, premiums, and deductibles change each year, so check the current Summary of Benefits on Florida Blue’s website or run your drug list through the Medicare Plan Finder at Medicare.gov before you commit.

Whichever route you choose, the single most useful thing you can do before enrolling is look up every medication you take on the plan’s formulary. Some drugs sit on higher tiers that cost more; others carry prior authorization, step therapy, or quantity limits that can delay your first fill. Those restrictions are shown next to each drug on the formulary.

Who Can Enroll

To join a Florida Blue Part D plan you need Medicare Part A, Part B, or both; you need to be a U.S. citizen or lawfully present; and you need to live in the plan’s service area.³ Service areas vary from plan to plan within Florida, so confirm the plan you want is actually offered at your address.

What You’ll Pay in 2026

Through 2024, Part D had four coverage phases and a middle “donut hole” where you paid 25% of drug costs. Federal law eliminated the gap starting in 2025, and 2026 keeps the simpler three-phase structure. The phases reset every January 1.¹

Deductible Phase

You pay the full negotiated price for covered drugs until you meet your plan’s deductible. No Part D plan can charge a deductible higher than $615 in 2026, and some plans set it at zero.⁴ Insulin is exempt from the deductible completely.⁵

Initial Coverage Phase

After you meet the deductible, you pay 25% coinsurance on covered drugs. This continues until your personal out-of-pocket spending on covered Part D drugs reaches $2,100.⁴

Catastrophic Phase

Once your out-of-pocket spending hits $2,100, you pay nothing for covered Part D drugs for the rest of the calendar year.⁴ The 5% coinsurance that used to apply in this phase before 2024 is gone.

Spreading the $2,100 Over the Year

Hitting $2,100 is good news in the long run, but it can land hard if you fill expensive prescriptions in January and February. Every Part D plan now has to offer the Medicare Prescription Payment Plan, which spreads your out-of-pocket drug costs across the calendar year in monthly installments instead of making you pay in full at the pharmacy counter.⁶

Enrollment is voluntary and free. There’s no interest and no participation fee. You pay the same total amount over the year; the plan just bills you monthly. If you’d rather budget roughly $175 per month than face a four-figure bill in the first weeks of the year, it’s worth signing up.⁶

Insulin and Vaccines

Every Part D-covered insulin product is capped at $35 per month’s supply, with no deductible, from your first fill of the year. A 90-day supply is capped at $105 total.⁵

Part D also covers most adult vaccines recommended by federal health authorities at zero cost. You pay no copay and no deductible for covered vaccines such as shingles (Shingrix), Tdap, and hepatitis A. Flu, COVID-19, and pneumococcal vaccines are covered under Part B, also at no cost.

If Your Drug Isn’t Covered

Finding out your medication isn’t on the formulary, or that it requires prior authorization, isn’t the end of the road. You have real options.

Formulary Exception

You or your doctor can ask the plan to cover a non-formulary drug or waive a restriction like step therapy. Your prescriber has to submit a supporting statement explaining why the covered alternatives won’t work for you.⁷ The plan must respond within 72 hours of getting that statement for a standard request, or 24 hours for an expedited request when your health is at risk.⁸

Appeal a Denial

If the plan says no, you can file a Level 1 appeal (a “redetermination”) within 60 days. The plan has 7 days to decide a standard benefits appeal, or 72 hours for an expedited one. If the plan still denies the drug, an Independent Review Entity outside the plan takes a fresh look.⁹ Further levels exist beyond that, including an administrative law judge hearing and ultimately federal court.

Transition Supply for New Members

If you just moved to a Florida Blue Part D plan and your medication isn’t on the new formulary, federal rules require the plan to give you a temporary transition supply during your first 90 days, typically a 30-day fill.¹⁰ Use that window to request a formulary exception or switch to a covered alternative.

Help With Costs if Your Income Is Limited

Extra Help, also called the Low-Income Subsidy, pays most or all of your Part D costs if you qualify. For 2026, the income limits are $23,940 for an individual or $32,460 for a married couple, and the resource limits are $18,090 (individual) or $36,100 (couple).¹¹

Beneficiaries who qualify pay:¹¹

$0 monthly premium
$0 deductible
No more than $5.10 per generic prescription
No more than $12.65 per brand-name prescription
$0 for all covered drugs after total drug costs reach $2,100

You qualify automatically if you have full Medicaid, get help from your state through a Medicare Savings Program, or receive Supplemental Security Income. Everyone else applies through Social Security.

IRMAA and the Late Enrollment Penalty

Higher-income beneficiaries pay an Income-Related Monthly Adjustment Amount, or IRMAA, on top of their Part D premium. It’s based on your modified adjusted gross income from two years prior, so your 2024 tax return drives your 2026 surcharge. For 2026, individuals with income at or below $109,000 (or $218,000 for married couples filing jointly) pay no surcharge. Above those thresholds, the Part D surcharge ranges from $14.50 to $91.00 per month depending on the bracket. If your income has dropped since the tax year being used, because of retirement or another qualifying life event, you can ask Social Security to recalculate.

If you go 63 or more consecutive days without Part D or equivalent drug coverage after your initial enrollment window closes, you owe a permanent late enrollment penalty on your monthly premium.¹² The penalty is 1% of the national base beneficiary premium times the number of full months you went without coverage. That base premium is $38.99 in 2026, so 14 uncovered months would add about $5.46 to your premium every month going forward.¹³ The dollar amount recalculates each year as the base premium changes.

When You Can Enroll

Initial Enrollment Period

Your first window runs seven months, starting three months before the month you turn 65 and ending three months after.¹⁴ People who qualify through disability get a similar window around their 25th month of disability benefits. Missing it without equivalent drug coverage triggers the late enrollment penalty.

Annual Enrollment Period

From October 15 through December 7 every year, anyone with Medicare can join, switch, or drop a Part D plan, with changes taking effect January 1.¹⁵ This is when to compare Florida Blue’s current lineup against your drug list. Formularies, premiums, and pharmacy networks change year to year.

Special Enrollment Periods

Certain life events open an out-of-cycle window, including moving out of your plan’s service area, losing employer-sponsored drug coverage, and qualifying for Extra Help.¹⁶

How to Sign Up

You can enroll in a Florida Blue Part D plan through the Medicare Plan Finder at Medicare.gov, directly on the Florida Blue website, or by calling Florida Blue’s enrollment line. The plan will confirm your effective date and send your member ID card by mail.

1
Centers for Medicare & Medicaid Services. Final CY 2026 Part D Redesign Program Instructions
2
Medicare.gov. What’s Medicare Drug Coverage (Part D)?
3
Centers for Medicare & Medicaid Services. Medicare Prescription Drug Eligibility and Enrollment
4
Medicare.gov. How Much Does Medicare Drug Coverage Cost?
5
Medicare.gov. Insulin
6
Medicare.gov. What’s the Medicare Prescription Payment Plan?
7
Centers for Medicare & Medicaid Services. Exceptions
8
Centers for Medicare & Medicaid Services. Coverage Determinations
9
Medicare.gov. Appeals in a Medicare Drug Plan
10
Centers for Medicare & Medicaid Services. Medicare Prescription Drug Benefit Manual Chapter 6
11
Medicare.gov. Help With Drug Costs
12
Centers for Medicare & Medicaid Services. Creditable Coverage and Late Enrollment Penalty
13
Medicare.gov. Avoid Late Enrollment Penalties
14
Medicare.gov. When Does Medicare Coverage Start?
15
Medicare.gov. Open Enrollment
16
Medicare.gov. Special Enrollment Periods