Prescription Drug Coverage Before Medicare: How to Lower Your Costs

Reviewed by Steve Turner, CLU, REBC · Florida License W333468 · NPN 18030539 · November 2026

On Medicare or turning 65? See Medicare Part D drug plans.

Key takeaways

• Before Medicare, drug coverage comes through your health plan, whether it’s a Marketplace, individual or job-based plan. There’s no separate “Part D” for people under 65.
• Choose your health plan by your prescriptions, not just the premium. Drug lists and costs vary a lot from plan to plan.
• Discount cards and assistance programs can help, but they aren’t insurance.
• No cost to you: I’m licensed in 8 states and paid by the insurance companies.

If you take regular prescriptions, your health plan largely determines what you’ll pay at the pharmacy. I’m Steve Turner, a licensed health insurance agent in Tampa since 2016. I compare plans using your exact medications and pharmacies, so you see the real yearly cost before you enroll. My help is free.

Where under-65 drug coverage comes from

• Marketplace and individual health plans. Every ACA-compliant plan covers prescription drugs as an essential health benefit. Each plan has its own drug list, tiers, and pharmacy network.
• Job-based coverage, through your employer or a spouse’s.
• Medicaid, if you qualify in your state.
• Medicare, if you’re under 65 and qualify because of a disability. Then Medicare Part D applies instead.

Short-term and other limited plans may cover few or no prescriptions, so check before you rely on one.

How health plans cover your prescriptions

• Drug lists (formularies) sort drugs into tiers, with generics usually cheapest.
• Deductibles: some plans make you meet the deductible before drug coverage starts; others charge flat copays from day one. This matters a lot if you take brand-name drugs.
• Out-of-pocket maximum: what you spend on covered drugs counts toward your plan’s yearly maximum.
• Pharmacy networks and mail order can change your cost for the same drug.
• If your drug isn’t covered, you can ask the plan for an exception with your doctor’s help.

Choose your plan by your prescriptions

The plan with the lowest premium isn’t always the cheapest once your prescriptions are counted. When we compare plans, I check:

• Every drug you take, at your dose, is on the drug list, and at what tier.
• Whether drug costs apply before or after the deductible.
• Your pharmacy is in network.
• Your estimated yearly total: premium plus drug costs, plus a buffer for a bad year.

Ways to lower costs beyond insurance

• Generic and lower-tier alternatives. Ask your doctor whether one works for you.
• 90-day and mail-order supplies for maintenance drugs.
• Manufacturer assistance programs for some brand-name drugs, if you qualify.
• Prescription discount cards. They’re free and can beat your copay on some drugs, but they aren’t insurance: what you pay usually doesn’t count toward your deductible or out-of-pocket maximum.

Marketplace open enrollment

For 2027 coverage, open enrollment runs November 1, 2026 to January 15, 2027 in most states, with December 15 as the deadline for coverage starting January 1. Losing job-based coverage, moving, or other life events can open a special enrollment period.

Where I can help

I’m licensed in all eight of these states and work with clients by phone, video, and e-signature, or in person at my Tampa office. Plan availability varies by state and county, so I’ll confirm which plans I can offer where you live:

Florida · Alabama · Colorado · Georgia · North Carolina · South Carolina · Tennessee · Texas

How I help

1. You send your prescription list with doses and pharmacies.
2. I compare plans by your total yearly cost, not just the premium.
3. I explain the trade-offs, including deductibles, tiers, and networks.
4. I help you enroll and apply any subsidy you qualify for.
5. I help when something changes, like a new prescription or a coverage denial.

Prescription coverage questions

Can I buy prescription drug insurance by itself if I’m under 65? Generally no. Before Medicare, drug coverage comes with a health plan. Stand-alone drug plans are for Medicare recipients.

Do Marketplace plans cover prescriptions? Yes. All ACA-compliant plans cover prescription drugs, but each plan’s drug list and costs vary, so it matters to compare.

Should I use a discount card or my insurance? For some drugs, a discount card costs less than your copay. Remember, discount-card purchases usually don’t count toward your deductible or out-of-pocket maximum.

What happens to my coverage when I turn 65? You’ll move to Medicare, and prescription coverage then comes through Medicare Part D. Plan for it a few months before your birthday to avoid a late penalty.

Talk with Steve

Call or text (813) 388-8373, seven days a week, 7 a.m.–8 p.m. Eastern, or book a call. Office: 14502 N Dale Mabry Hwy, Suite 200, Tampa, FL 33618.

Related: Individual & family health insurance · Medicare Part D drug plans · All areas we serve