Medicare Part D

How Part D Works in 2026: $615 Deductible, $2,100 Cap

ROCHESTER HILLS, Mich. — If you take prescription drugs and have Medicare, 2026 brings some of the most important Part D changes in years. There's a new yearly cap on what you pay out of pocket, a set maximum deductible, and a simpler three-phase structure now that the old "donut hole" is gone.

Here's a plain-language look at how Part D will work in 2026, and where Rochester Hills readers can go for help sorting it out.

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

Starting in 2026, no one with Medicare Part D will pay more than $2,100 out of pocket for covered prescription drugs in a calendar year. Once your out-of-pocket spending on covered drugs hits that number, you pay $0 for the rest of the year on those drugs.

This cap applies whether you have a stand-alone Part D plan or drug coverage built into a Medicare Advantage plan. It's a program-wide rule set by Medicare, according to CMS — Medicare Part D program rules (medicare.gov).

The deductible: up to $615

Part D plans can charge a yearly deductible before your drug coverage kicks in. For 2026, the maximum allowed deductible is $615.

Plans can set their deductible lower than that — some charge nothing, some charge the full amount, and some fall in between. The key point: no Part D plan can charge more than $615 as a deductible in 2026.

The three phases of Part D in 2026

Since 2025, the coverage gap (the old "donut hole") has been eliminated. That leaves three phases in Part D:

1. Deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible (up to $615). 2. Initial coverage phase. After the deductible, you pay a copay or a share of the cost for each prescription. Your plan pays the rest. 3. Catastrophic phase. Once your out-of-pocket spending reaches $2,100, you pay $0 for the rest of the year on covered drugs.

That's it — three phases, one cap, one deductible ceiling. Much simpler than the four-phase system many people remember.

A new option: spreading drug costs over the year

If a $2,100 bill hitting in January or February sounds hard to manage, Medicare offers the Medicare Prescription Payment Plan. It's optional and free to join.

Instead of paying the pharmacy directly when you fill a prescription, you get a monthly bill from your Part D plan that spreads your yearly drug costs across the calendar year. You still pay the same total — it just arrives in smaller, more predictable pieces.

You can sign up before the plan year starts or at any point during the year. Details are at medicare.gov.

What this looks like in Rochester Hills

Rochester Hills is in Oakland County, where Medicare beneficiaries can choose between stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. The exact number of options and the specifics of each plan change every year, so the fall Annual Enrollment Period is a good time to compare.

The rules above — the $615 deductible ceiling, the $2,100 cap, the three phases — apply to every Part D plan in Oakland County and everywhere else in the country. What differs plan to plan is the premium, the drug list (formulary), the pharmacy network, and copay amounts.

Key dates to remember

• Annual Enrollment Period: October 15 – December 7. This is when most people join, switch, or drop a Part D or Medicare Advantage plan for the following year.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare with a stand-alone Part D plan.

A note on higher-income surcharges

If your income is above $109,000 as a single filer (or $218,000 for a married couple filing jointly), you may pay an IRMAA surcharge on top of your Part D premium in 2026. This is based on your tax return from two years earlier. Medicare will send a letter if it applies to you, and you can appeal if your income has dropped due to a life event like retirement.