Medicare Part D
Why Fridley Retirees Should Note Medicare's $2,100 Cap
FRIDLEY, Minn. — Starting Jan. 1, 2026, the biggest change to Medicare drug coverage in a generation moves into its next chapter: a hard $2,100 cap on what enrollees pay out of pocket for covered prescriptions under Part D. For Fridley-area retirees who have watched pharmacy bills climb year after year, the new ceiling — up from $2,000 in 2025 — is the headline change to understand before the Annual Enrollment Period closes on Dec. 7.
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Key takeaways
- In 2026, Part D out-of-pocket drug costs are capped at $2,100 per year, according to Medicare Part D program rules on medicare.gov.
- The old "donut hole" coverage gap is gone; Part D now has three phases — deductible, initial coverage, and catastrophic.
- The Medicare Prescription Payment Plan lets you spread that $2,100 across monthly installments instead of paying it all at the pharmacy counter.
- The Annual Enrollment Period runs Oct. 15 through Dec. 7, and changes made during that window take effect Jan. 1, 2026.
What the $2,100 cap actually means
Once your out-of-pocket spending on covered Part D drugs hits $2,100 in 2026, you pay $0 for the rest of the calendar year on those prescriptions. The cap applies to standalone Part D plans and to the drug coverage built into most Medicare Advantage plans.
A few things to keep in mind: the cap counts what you spend on covered drugs at in-network pharmacies. Monthly premiums don't count toward it, and drugs your plan doesn't cover don't count either. The Part D deductible in 2026 can be as high as $615, and whatever you pay toward that deductible does count toward the $2,100.
The coverage gap is really gone
For years, the "donut hole" was the confusing middle stretch where many people suddenly paid a bigger share of their drug costs. That phase was eliminated in 2025, and it stays gone in 2026. Part D now has three phases instead of four:
1. Deductible phase — you pay full negotiated price until you meet the plan's deductible (up to $615). 2. Initial coverage phase — you pay a share (generally up to 25%) of drug costs. 3. Catastrophic phase — once you hit the $2,100 cap, you pay nothing for covered drugs the rest of the year.
That simpler structure is the reason the annual cap now has a clean dollar figure attached to it.
The Medicare Prescription Payment Plan
Hitting $2,100 in January is still a lot to pay at once, especially for people on expensive specialty medications. That's what the Medicare Prescription Payment Plan is designed to soften.
It's optional and free to join. Instead of paying the pharmacy directly at pickup, you pay $0 at the counter and your Part D plan bills you monthly for what you would have owed, spread across the remaining months of the year. Your total for the year doesn't change — you just get more predictable monthly bills.
You can opt in before the plan year starts or at any point during the year by contacting your Part D or Medicare Advantage plan. Medicare recommends the program most strongly for people with high drug costs early in the year.
What Fridley residents should check during AEP
Fridley is in Anoka County, where Medicare beneficiaries can compare standalone Part D drug plans and Medicare Advantage plans that include drug coverage. Plan formularies (the list of covered drugs), pharmacy networks, and premiums are set at the plan and county level and change every year — so a plan that worked well in 2025 may cover your medications differently in 2026.
A few practical steps before Dec. 7:
- Read the Annual Notice of Change your current plan mailed you in September.
- Use the Plan Finder tool at medicare.gov to enter your prescriptions and see how each available plan would handle them in 2026.
- If your income is above $109,000 (single filer) or $218,000 (joint), check whether an IRMAA surcharge applies to your Part B and Part D premiums.
If you miss AEP and are on a Medicare Advantage plan, the Medicare Advantage Open Enrollment Period (Jan. 1 – March 31) gives you one more chance to switch Advantage plans or return to Original Medicare.
Where to get unbiased help
You don't have to figure this out alone, and you don't have to talk to a salesperson to get answers. Free, one-on-one counseling is available through Minnesota's State Health Insurance Assistance Program (SHIP), called the Senior LinkAge Line at 1-800-333-2433. Counselors are trained volunteers and staff who don't sell plans.
You can also call 1-800-MEDICARE (1-800-633-4227), 24 hours a day, or visit medicare.gov to compare plans, check drug coverage, and read the official 2026 program rules.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Anoka County
(MA penetration in Anoka County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Prescription coverage
How Medicare Part D works in 2026
The old coverage gap (“donut hole”) is eliminated as of 2025 (three phases now). There’s now a hard yearly cap of $2,100 on what you pay out of pocket for covered drugs, and you can spread those costs across the year with the Medicare Prescription Payment Plan.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Does the $2,100 cap include my monthly Part D premium?
Do I have to sign up for the Medicare Prescription Payment Plan?
What happens to my leftover donut hole costs from past years?
When do 2026 changes take effect if I switch plans during AEP?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Also for Fridley
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This page was last updated: September 2026.