Medicare Part D

Medicare Part D in 2026: How the $2,100 Cap Works

Greenwich, Connecticut — If you take prescription drugs and have Medicare, 2026 brings some of the biggest Part D changes in years. There's a firm new ceiling on what you'll pay out of pocket, a lower maximum deductible than many people expect, and a simpler three-phase structure now that the old "donut hole" is gone.

Here's a plain-English walk through how Part D works this year, with a few notes for readers in Greenwich and the rest of Fairfield County.

The headline number: a $2,100 out-of-pocket cap

The most important change to know: in 2026, your out-of-pocket spending on covered prescription drugs is capped at $2,100. Once you hit that limit, you pay $0 for covered drugs for the rest of the calendar year.

This cap applies whether you get your drug coverage through a stand-alone Part D plan or through a Medicare Advantage plan that includes drug coverage. It does not include your monthly premium — just what you spend on covered medications at the pharmacy.

For anyone in Greenwich who has faced a rough year with specialty drugs or a long list of prescriptions, this is a real guardrail. The cap resets each January 1.

The three phases of Part D in 2026

Part D used to have four phases, including the confusing "coverage gap." As of 2025, that gap is gone. Now there are just three phases:

1. Deductible phase. You pay the full negotiated price of your drugs until you meet your plan's deductible. In 2026, the maximum deductible any Part D plan can charge is $615. Some plans set it lower; none can set it higher.

2. Initial coverage phase. After the deductible, you pay a copay or coinsurance for each prescription, and your plan pays the rest. You stay in this phase until your total out-of-pocket spending reaches $2,100.

3. Catastrophic phase. Once you hit $2,100, you pay nothing for the rest of the year on covered drugs.

That's it. Three phases, one cap, one calendar year.

The Medicare Prescription Payment Plan

If a $2,100 bill in January would be hard to handle, there's a newer option worth knowing about: the Medicare Prescription Payment Plan. This is a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying big amounts at the pharmacy counter.

It doesn't lower what you owe — it just smooths it out. You can sign up through your Part D or Medicare Advantage drug plan. If you take an expensive medication early in the year, this may be worth a call to your plan.

A quick local note on availability

Greenwich sits in Fairfield County, and Medicare plan availability is set at the county level, not by town. Fairfield County residents have access to multiple stand-alone Part D plans and Medicare Advantage plans with drug coverage. The exact list changes each year, so it's worth checking during open enrollment even if you liked your plan last year — formularies, pharmacy networks, and costs can shift.

You can compare what's available in your ZIP code using the Plan Finder at medicare.gov.

Higher-income surcharges (IRMAA)

If your income is above certain thresholds, you'll pay an extra amount on top of your Part D premium called IRMAA (Income-Related Monthly Adjustment Amount). For 2026, IRMAA surcharges begin above $109,000 in income for a single filer (higher for joint filers). Social Security uses your tax return from two years earlier to decide.

This is worth flagging in a place like Greenwich, where more households cross those income lines than the national average. If your income has recently dropped — say, because you retired — you can ask Social Security to reconsider using Form SSA-44.

Key dates to remember

• October 15 – December 7: Medicare Annual Enrollment Period. You can switch Part D plans, change Medicare Advantage plans, or move between Original Medicare and Advantage. Changes take effect January 1.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare (and add a stand-alone Part D plan).

Missing these windows usually means waiting a full year, so mark the calendar.