How Do Prescription Drug Plans Work?
Here is important information you need to know about owning a prescription drug plan:
Annual Deductible - Your Part D plan may have an annual deductible before the plan begins sharing the cost of covered prescriptions. In 2026, no Medicare drug plan may have a deductible higher than $615, and some plans may have a lower deductible or no deductible at all.
Initial Coverage - After meeting your plan's deductible, if applicable, you enter the initial coverage stage. Under the standard 2026 Part D benefit, you generally pay 25% of the cost of covered Part D drugs until your qualifying out-of-pocket spending reaches $2,100 for the year. Your actual copayments or coinsurance can vary depending on your specific plan, formulary, pharmacy, and medication.
No Traditional Coverage Gap - The old Part D "coverage gap," commonly called the donut hole, is no longer a separate coverage stage. The current Part D benefit generally moves from the deductible stage to initial coverage and then to catastrophic coverage once the annual out-of-pocket limit is reached.
$2,100 Annual Out-of-Pocket Limit - In 2026, your out-of-pocket costs for covered Part D prescription drugs are capped at $2,100 for the calendar year. Certain payments made on your behalf may also count toward this threshold.
Catastrophic Coverage - Once you reach the $2,100 out-of-pocket threshold, you enter catastrophic coverage. For the remainder of the calendar year, you generally pay $0 out of pocket for covered Part D drugs.
Medicare Prescription Payment Plan - Medicare drug plans also offer an optional payment program that allows you to spread your out-of-pocket prescription costs over the calendar year. This program can help manage monthly expenses, but it does not reduce the total cost of your medications.
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