When helping a loved one who uses several prescriptions, the most important Medicare comparison is often not the plan's headline benefits. It is whether their exact medications, dosages and pharmacy fit the coverage they will have next year. For families coordinating Medicare and Florida Medicaid, this review is especially valuable before making changes.
Quick answer: What should a Florida guardian check for 2027?
Start with a complete medication list. Compare each prescription against the plan's 2027 drug list and coverage restrictions, verify the pharmacy's network status, review estimated annual costs, and confirm how Medicare drug coverage fits the person's current health plan and Medicaid assistance. Do not change coverage solely because a plan advertises an attractive premium or extra benefit. [2] [3] [5] [7]
Medicare's Annual Open Enrollment runs October 15 through December 7, 2026 for coverage changes generally effective January 1, 2027. The enrollment rules and options depend on the person's existing coverage. [1]
A nine-point medication and pharmacy checklist
1. Make one accurate medication list
Record the prescription name, generic or brand name, dosage, strength, form (such as tablet, liquid or injection), frequency, and usual monthly quantity. Note each prescribing clinician and the pharmacy currently used. Include medications from specialists and any prescriptions managed by a caregiver or facility. Ask the pharmacist or prescribers to help reconcile conflicting lists. A precise list matters because a plan may cover one form or strength but not another. [2] [3]
2. Identify where Medicare drug coverage comes from now
Check whether the beneficiary has Original Medicare plus a separate Part D plan, or a Medicare Advantage plan that includes drug coverage. This is not a technicality: joining a separate Part D plan can cause disenrollment from certain Medicare Advantage plans. Confirm the existing coverage before requesting any change, especially if the person also uses a D-SNP or receives coordinated services. [7] [12]
3. Look up every drug in the proposed plan's 2027 formulary
A formulary is the plan's covered-drug list. Review each drug's presence and tier, rather than assuming that an existing prescription remains covered next year. Formularies and cost-sharing rules vary by plan; a listed generic and a specific brand-name drug are not necessarily treated identically. If a needed medication is absent, ask the plan and prescriber about clinical alternatives or the exception process before taking action. [3]
4. Check restrictions, not just whether the medication is listed
A drug may be on the formulary but subject to prior authorization, step therapy, or quantity limits. Ask whether these rules apply to the specific medication and what paperwork a prescriber may need to provide. Medical necessity does not by itself guarantee that a plan will approve the requested medicine; plans have coverage and appeals procedures. [4]
5. Confirm the exact pharmacy location and delivery options
Ask whether the beneficiary's usual pharmacy is in the 2027 plan's network, and whether it is considered a preferred pharmacy. Verify the actual address, not just the pharmacy chain's name. If a family member depends on delivery or a facility coordinates refills, check that the proposed pharmacy arrangement is available. A pharmacy that worked with the current plan may have different network or cost-sharing arrangements next year. [5]
6. Compare estimated yearly drug costs with assistance included
Use Medicare's plan comparison tool to enter prescriptions and compare projected costs, and confirm the details with the plan. If the beneficiary gets full Medicaid, certain Medicare Savings Program assistance, or Supplemental Security Income (SSI), they generally qualify automatically for Medicare's Extra Help with Part D expenses. Extra Help can reduce costs, but it does not mean every drug or pharmacy is covered or that every prescription will cost $0. [2] [6]
7. Review Medicare and Florida Medicaid separately
For a person with both programs, Medicare generally provides prescription drug coverage, while Medicaid may assist with other covered services and may cover certain drugs in limited circumstances. Medicare Advantage coverage, Part D coverage, and Florida Medicaid arrangements are not interchangeable. If a drug or cost seems wrong, first determine which program and plan are responsible. For Medicaid-specific questions, Florida's Agency for Health Care Administration (AHCA) lists recipient resources and its Medicaid Helpline at 1-877-254-1055. [10] [12]
8. Plan ahead for refills and possible coverage problems
If a required medicine faces a new restriction, ask the prescriber and plan what documentation, alternatives, or exception requests may be needed before a refill is due. Certain transition-fill protections may apply when new drug coverage begins, but they are not a guarantee of ongoing coverage. Keep copies of plan notices and pharmacy receipts, and ask the plan how to address an incorrect charge. Do not stop or substitute prescribed medication without the treating clinician's guidance. [4] [8]
9. Confirm who is authorized to discuss and change coverage
A relative, caregiver, or guardian should know what authorization the plan or agency requires before requesting private information or acting for a beneficiary. A health care power of attorney or guardianship authority may affect who can access records and make decisions; state law and the scope of the authorization matter. Protect Medicare numbers, passwords and medication records rather than submitting them through public comments or general messages. [10] [11]
A practical comparison worksheet
For each plan under consideration, make a simple side-by-side sheet with five columns: medication and exact form, covered and tier, authorization or quantity rules, pharmacy arrangement, and estimated cost. Highlight unanswered questions to ask the plan or prescriber. Separately note whether switching a Medicare health plan could affect doctors, specialists, or care coordination—not just prescriptions. [2] [3] [7]
Frequently asked questions
Does having Medicare and Medicaid make prescriptions free?
Not necessarily. Full Medicaid generally brings automatic eligibility for Medicare Extra Help, but actual costs and coverage still depend on the person's assistance level, the drug, the pharmacy and the plan's rules. Check the current Medicare notice and plan information instead of assuming a $0 charge. [6] [12]
Can a guardian add a stand-alone Part D plan to any Medicare Advantage plan?
No. Many Medicare Advantage plans already include Part D. In certain plan types, joining a separate prescription drug plan can disenroll the person from Medicare Advantage and return them to Original Medicare. Ask Medicare or the current plan about the consequences before enrolling. [7]
Does an in-network pharmacy this year remain in-network in 2027?
Do not assume so. Check the new plan year's pharmacy directory or contact the plan, particularly when transportation, mail order, or facility-administered refills matter. Costs can also differ between standard and preferred network pharmacies. [5]
What if the 2027 plan will not cover a medication?
Ask the plan whether the drug has an approved alternative or whether the prescriber can request a formulary or coverage-rule exception with clinical support. Ask about transition fills if coverage is newly starting. Approval is not automatic. [3] [4]
Must the family change plans during Open Enrollment?
No. A review is worthwhile, but a change is not automatically necessary. Compare the current coverage with available alternatives, and make an enrollment request only if there is a reason to change and the person is eligible. The regular Medicare Open Enrollment deadline for January 2027 changes is December 7, 2026. [1] [2]
Where Florida families can get help
Independent public-program counseling: Florida's SHINE program offers free, unbiased Medicare counseling to beneficiaries, families and caregivers. You can also compare options directly at Medicare.gov or call 1-800-MEDICARE (1-800-633-4227). [9]
Optional private agency help: Arch Care Partners can help families organize questions about Medicare and Medicaid coordination and explore coverage options in a private conversation. You are under no obligation to enroll through ACP. To read additional guidance, visit the Families & Guardians resource center.
Need help reviewing a loved one's coverage?
Start with a free, no-pressure coverage evaluation. No enrollment is required to read this guide or use government resources.
Educational and non-affiliation notice: Arch Care Partners is an independent insurance agency. It is not Medicare, CMS, Florida Medicaid or SHINE, and is not endorsed by any government program. This educational article is not a benefit quote, medical recommendation, eligibility decision, guarantee of drug or pharmacy coverage, or promise of savings. ACP's site-wide footer contains additional applicable marketing disclosures. You can review all available Medicare options at Medicare.gov or by calling 1-800-MEDICARE.
Sources and verification links
Numbers in the article refer to these official government or Florida public-program resources. Information was reviewed October 24, 2026; always check the current plan documents and notices.
- Medicare.gov — Medicare Open Enrollment
- Medicare.gov — Joining a plan and comparing prescription costs
- Medicare.gov — How drug plans work and formularies
- Medicare.gov — Drug plan rules, prior authorization and exceptions
- Medicare.gov — Pharmacy networks and preferred pharmacies
- Medicare.gov — Extra Help with Part D costs
- Medicare.gov — How to get Medicare drug coverage
- Medicare.gov — Using Medicare drug coverage
- Florida SHINE — Free Medicare counseling
- Florida AHCA — Medicaid recipient resources and assistance
- HHS — Personal representatives under HIPAA
- Medicare.gov — Medicare and Medicaid coordination
