Medicare Part D

Medicare's New $2,100 Drug Cap: What Changes in 2026

JUNCTION CITY, Kan. — Starting January 1, 2026, everyone with Medicare Part D drug coverage will have a hard limit on what they pay out of pocket for covered prescriptions each year: $2,100. Once you hit that number, you pay $0 for the rest of the calendar year on covered drugs.

A big shift for prescription costs starts January 1

That is the single biggest change coming to Medicare drug coverage this season, and it lands right as the Annual Enrollment Period (October 15 – December 7) is underway. If prescription costs have been a strain, this is the year to pay close attention.

The $2,100 out-of-pocket cap, explained

For years, people with expensive medications could spend many thousands of dollars a year at the pharmacy. The new cap changes that math.

Here is what counts toward the $2,100:

• Your Part D deductible (up to a maximum of $615 in 2026)
• Copays and coinsurance for covered drugs at the pharmacy

Once your out-of-pocket spending on covered drugs reaches $2,100, you move into the "catastrophic" phase, and you pay nothing more for those covered drugs for the rest of the year. Monthly plan premiums do not count toward the cap.

This cap applies whether you get your drug coverage through a stand-alone Part D plan or through a Medicare Advantage plan that includes drugs.

The "donut hole" is gone

If you have been on Medicare for a while, you may remember the coverage gap, often called the donut hole — a middle phase where you suddenly paid a bigger share of your drug costs.

As of 2025, the donut hole was eliminated. In 2026, Part D has just three phases:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (no more than $615). 2. Initial coverage phase — you pay a copay or coinsurance for each prescription. 3. Catastrophic phase — after $2,100 in out-of-pocket costs, you pay $0 for covered drugs.

Simpler, and easier to plan around.

The Medicare Prescription Payment Plan: spreading costs across the year

Hitting a $2,100 cap is helpful, but many people still worry about a big bill in January or February if an expensive prescription comes early in the year.

That is what the Medicare Prescription Payment Plan is for. It 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 the pharmacy all at once.

A few things to know:

• You still pay the same total amount for the year — this is smoothing, not a discount.
• You sign up through your drug plan, not at the pharmacy counter.
• It is most useful for people with high drug costs early in the year.
• You can opt in at any time, though signing up before the year starts gives you the full benefit.

If you take a costly specialty medication, ask your plan whether this option makes sense for you.

What this means for people in Junction City

Junction City is in Geary County, where Medicare beneficiaries choose between Original Medicare (often paired with a stand-alone Part D plan) and Medicare Advantage plans that include drug coverage. The $2,100 cap, the $615 maximum deductible, and the payment plan apply the same way across every county — these are federal Part D rules, not local ones.

What does vary locally is which plans are offered, which pharmacies are in-network, and which drugs are on each plan's formulary. That is why the fall enrollment window matters: it is your chance to check that your medications are still covered by your plan for 2026, and at what tier.

A quick word on IRMAA

Higher-income enrollees pay an extra amount on top of their Part B and Part D premiums, called IRMAA (Income-Related Monthly Adjustment Amount). For 2026, IRMAA surcharges start above $109,000 in modified adjusted gross income for a single filer (higher for joint filers). Social Security notifies you if it applies, based on your tax return from two years earlier.