Eliquis, Jardiance, and Insulin on a $0-Premium Part D Plan vs. a $36/Month Plan: How to Compare Your 2027 Costs Before December 7
You take Eliquis 5 mg twice a day, Jardiance 10 mg once a day, a basal insulin (one box of insulin glargine pens a month), and atorvastatin 40 mg. Open Enrollment for 2027 coverage runs October 15 through December 7. Two Part D plans in your ZIP code both cover all four drugs, and one has a $0 premium. Which one costs less?
The answer is not the one with the lower premium, and it is not the same for every reader. This post works through the math for that exact drug list on two plans, then shows how the winner flips when the list changes.
A note on the numbers. Plan A and Plan B below are illustrative plans I built to show the arithmetic. They are not real plans in your ZIP code. I used the 2026 Part D parameters and negotiated prices because those are the figures I can verify. CMS publishes the 2027 figures each year, so plug the 2027 values into the same steps when you check Medicare Plan Finder. The method does not change.
What the Part D redesign and drug negotiation changed
Three policy changes from the Inflation Reduction Act (IRA) set the ground rules. Each is explained here without the jargon.
- The donut hole is gone. The old coverage gap ended in 2025. After you pay your deductible and your share of drug costs, there is now a hard ceiling on what you spend in a calendar year.
- The ceiling is indexed. It was $2,000 in 2025 and $2,100 in 2026, and it adjusts each year. Some older articles still say $2,000, so check the current figure. The running tally that counts toward the ceiling is called TrOOP, short for "true out-of-pocket." Your own payments count. Most coupon and discount-card payments do not (more on that below).
- The deductible is capped by law. The maximum Part D deductible was $615 in 2026. Plans can charge less, and many charge $0 on some tiers.
Negotiated prices matter too. For 2026, Medicare's negotiated "maximum fair price" took effect for the first ten drugs. That price is what the plan pays the pharmacy, and it is the number your cost-sharing is calculated from.
| Drug | 2026 negotiated price (30-day supply) |
|---|---|
| Eliquis | $231 |
| Jardiance | $197 |
| Farxiga | $178.50 |
| Entresto | $295 |
CMS's second round of negotiated prices takes effect January 1, 2027. It includes Ozempic and Wegovy at $274 per month. If you take one of the second-round drugs, your 2027 math is different from your 2026 math. Verify each drug's price on Plan Finder.
For the drug-by-drug view of those prices, see our Eliquis negotiated-price plan comparison.
The worked example: $0 premium vs. $36 a month
Here are the two plans.
| Feature | Plan A ($0 premium) | Plan B ($36/month premium) |
|---|---|---|
| Annual premium | $0 | $432 |
| Deductible | $615 on brand tiers | $0 |
| Eliquis (Tier 3) | 25% after deductible | $47 flat copay |
| Jardiance (Tier 3) | 25% after deductible | $47 flat copay |
| Atorvastatin (Tier 1) | $5 | $0 |
| Insulin glargine | $35 (capped by law) | $35 (capped by law) |
Insulin is exempt from the deductible under the IRA's $35 cap. That is why it is a flat $35 in January on both plans.
Plan A, month by month
- January: Eliquis ($231) and Jardiance ($197) both land in the deductible, so you pay $428. Add $35 for insulin and $5 for atorvastatin: $468.
- February: $187 of deductible remains. You pay $187, plus 25% of the remaining $44 on Eliquis ($11), plus 25% of Jardiance ($49.25). With insulin and atorvastatin, February costs $287.25.
- March through November: Coinsurance is 25% of $428, which is $107. Add $40 for insulin and atorvastatin: $147 a month, or $1,323 for the nine months.
- December: You are $21.75 short of the cap. You pay $21.75 and then nothing more.
The total is $2,100, the 2026 out-of-pocket ceiling, and you hit it in your last fill of the year. The $0 premium plan spent 12 months getting you to the cap.
Plan B
Plan B has no deductible and flat copays: $47 + $47 + $35 + $0 = $129 a month. That is $1,548 a year in cost-sharing, well under the cap, so the cap never comes into play. Add the $432 in premiums:
| Plan A | Plan B | |
|---|---|---|
| Premiums | $0 | $432 |
| Cost-sharing | $2,100 | $1,548 |
| Total annual cost | $2,100 | $1,980 |
| January out-of-pocket | $468 | $165 (incl. premium) |
The "cheaper" plan is $120 more expensive over the year. It also costs $303 more in January. This is the kind of comparison Pelandri runs for you across your drug list, so you don't have to build the spreadsheet yourself.
The break-even premium
Plan B saves you $552 in cost-sharing ($2,100 minus $1,548). Divide by 12 and you get $46 a month. Any Plan B premium under $46 beats Plan A for this drug list, and any premium over $46 loses. A $36 premium wins by $10 a month. A $55 premium would lose by $9 a month.
I have seen this break-even used to compare two real plans in the same ZIP code. The published premium tells you almost nothing until you attach a drug list to it. Our earlier comparison of a $38/month plan and a $0-premium plan for Eliquis and Jardiance shows the same pattern with different numbers.
The winner flips when your drug list changes
Here is the same pair of plans with three different lists. Nothing about the plans changed. Only the drugs did.
| Drug list | Plan A total | Plan B total | Cheaper plan |
|---|---|---|---|
| Eliquis + Jardiance + insulin + atorvastatin | $2,100 | $1,980 | Plan B by $120 |
| Eliquis + insulin + atorvastatin | $1,634 | $1,416 | Plan B by $218 |
| Insulin + atorvastatin only | $480 | $852 | Plan A by $372 |
The second row also shows why the cap month moves. Without Jardiance, Plan A never reaches the $2,100 ceiling. It pays out $1,634 across the year, so you get no catastrophic-phase relief at all. Every brand-name drug on your list adds about $49 to $58 a month to your Plan A tally after the deductible, so the month you hit the cap depends on which drugs you take.
If you take only insulin and generics, the $0-premium plan is the better buy. That is the honest answer, and it is why "always pick the lowest premium" and "always pick the lowest copay" are both wrong. Only your own list can settle it.
The January cash-flow problem, and one way around it
Plan A's front-loaded deductible is a cash-flow problem even if the annual total is fine. You would pay $468 in January and $287.25 in February. Medicare's Medicare Prescription Payment Plan lets you opt in through your plan and spread your costs across the year in monthly bills. The bills are capped at your remaining out-of-pocket amount divided by the months left, so about $175 a month if you start in January and expect to reach the $2,100 cap. It does not lower your total. It only smooths the timing.
For the pharmacy-side effect on timing, see our post on how insurer-owned pharmacies change when you hit the cap. You can model this for your specific situation at Pelandri.
What the $35 insulin cap does and does not guarantee
The IRA's $35 monthly limit applies to each covered insulin product a plan covers, with no deductible. That is why insulin was the same $35 on both plans above. Three details still matter:
- Plans can charge less than $35. The cap is a ceiling, not a price.
- The insulin has to be on your plan's formulary. A plan that drops your specific pen or vial from its formulary is not bound by the cap for that product. Check the exact product, not just "insulin."
- Coupons do not substitute. A discount-card price does not count toward your TrOOP, so it does not move you toward the cap. The GoodRx coupon vs. Part D comparison for Eliquis shows what that costs in practice. Our post on whether the insulin cap is at risk covers what the law does and does not protect.
What this fall's news means for your plan decision
Three of the recent stories from our reading list bear on this decision. I am not weighing in on the politics. These are the practical takeaways.
Premiums and deductibles are in the headlines. KFF Health News's coverage of midterm voters and "sticker shock at the doctor's office" notes that steep jumps in premiums and deductibles are on many voters' minds. Election Day is November 3, in the middle of the Open Enrollment window. Your plan choice will be decided by your own arithmetic, not by the campaign season, and the December 7 deadline does not move.
Some people will lose Medicare eligibility, which changes their Part D situation. Medicare Rights Center's piece "Thousands of Immigrants Scheduled to Lose Medicare Coverage in the New Year" reports on comments to a proposed CMS rule implementing eligibility changes for certain immigrants under H.R. 1. Part D coverage depends on Medicare eligibility. If you or a family member could be affected, treat this as more than a plan-comparison question. A State Health Insurance Assistance Program (SHIP) counselor can confirm status, timing, and what coverage options exist. You can find yours at shiphelp.org.
Medicaid changes can ripple into Extra Help. KFF Health News reports that Medicaid budget cuts and policy uncertainty are putting nutrition programs, including meal delivery, at risk, and that one state has already reconsidered coverage. If you are on Medicaid or a Medicare Savings Program, your Extra Help (the low-income subsidy) can hinge on that status. Extra Help changes the whole calculation above, and it can cut a bill like this one to a fraction of the amount. Our post on Eliquis and Jardiance with Extra Help and the Medicaid work requirement walks through it.
Your four variables, in order
Your best plan comes down to four inputs:
- Your exact drug list, with dosages. This matters most. The worked example flipped winners with a single drug change. Include the brand or generic form and how many days each fill covers.
- Your pharmacy. Preferred-network pharmacies charge lower copays on many plans. Mail order can lower them further. If your plan owns the pharmacy chain, the prices can differ from an independent pharmacy.
- Your income. Check Extra Help and Medicare Savings Program eligibility before you compare anything. If you qualify, the comparison table above does not apply to you.
- Your ZIP code. Which plans exist, and at what premium, changes at the county level. A plan on a neighbor's list may not be sold at your address.
Also check each drug for prior authorization and step therapy, which are plan rules requiring approval or trying another drug first. They are listed in the plan's formulary documents and often skipped in premium comparisons.
A note on our data
I built the worked example from CMS's published Part D design parameters and negotiated prices, not from marketplace data. Pelandri's data layer (12,086 rows across six sources, including cms-marketplace-plans with 4,080 rows, bls-medical-cpi with 1,080 rows, census-acs-health-coverage with 6,286 rows, employer-plan-data with 400 rows, aca-subsidy-params with 210 rows, and plan-defaults with 30 rows) covers ACA and employer coverage. It becomes relevant if you are turning 65 and leaving a marketplace or employer plan, and I have not used it for any figure in this post. Part D formulary and tier data comes from the plan files CMS publishes each fall.
Do this before December 7
- Write down every drug, dose, and pharmacy. Include the insulin brand and pen or vial.
- For each plan in your ZIP code, get the premium, the deductible, and the cost of each drug by tier. Use Medicare Plan Finder or a comparison tool.
- Add them up: premium × 12, plus deductible, plus monthly copays or coinsurance until you hit TrOOP.
- Find the break-even premium against your current plan, as we did above.
- Ask about the Prescription Payment Plan if a large January bill would strain your budget.
- Enroll before December 7. Coverage starts January 1.
The math above shows that a $0 premium and a $36 premium can be $120 apart, and that $120 can go either direction depending on your medications. Run your own list through Pelandri's Part D comparison before Open Enrollment closes. It takes a few minutes, and it replaces guessing with your own numbers. This post is educational and not medical advice. Talk to your prescriber or pharmacist before changing any medication.
Data behind this post
The figures above are computed from the product's own reference tables, last refreshed 2026-04-15:
- 210 rows from aca-subsidy-params
- 1,080 rows from bls-medical-cpi
- 6,286 rows from census-acs-health-coverage
- 4,080 rows from cms-marketplace-plans
- 400 rows from employer-plan-data
- 30 rows from plan-defaults
Sources
- Thousands of Immigrants Scheduled to Lose Medicare Coverage in the New Year — Medicare Rights Center
- Health Journalists Visit Conservative Georgia District and Weigh AI Bioweapon Threat — KFF Medicare
- Sticker Shock at the Doctor’s Office Could Motivate Midterm Voters — KFF Medicare
- Cost-Saving Medicaid Meal Deliveries Threatened by Cuts, Policy Uncertainty — KFF Medicare
- California Eyes Prison Heat Protections That Fall Short of Workplace Standards — KFF Medicare