Medicare Part D

Part D in Webster Groves: $2,100 Cap and New Phases

WEBSTER GROVES, Mo. — If you take prescription drugs and pay for them through Medicare, 2026 brings some of the biggest changes Part D has seen in years. The coverage gap is gone, a hard yearly cap on what you pay out of pocket is now in place, and the program has been simplified into three straightforward phases.

Here is a plain-English guide to how Medicare Part D works this year, and where Webster Groves residents can go for help.

The three phases of Part D in 2026

Since 2025, Medicare Part D has been organized into three phases instead of four. Here is how they work in 2026:

1. Deductible phase. You pay the full negotiated price of your drugs until you meet your plan's deductible. Plans can set any deductible up to the federal maximum of $615 for 2026. Some plans use a lower deductible, and some drugs may be covered before the deductible is met — that depends on the plan.

2. Initial coverage phase. Once the deductible is met, you pay a share of the cost (a copay or coinsurance) and your plan pays the rest. You stay in this phase until your out-of-pocket spending on covered drugs reaches $2,100.

3. Catastrophic phase. After you hit the $2,100 cap, you pay $0 for the rest of the year on covered Part D drugs. This is the biggest change from years past — there is now a firm ceiling on what you spend.

What "$2,100 out-of-pocket cap" really means

The $2,100 cap applies to what you spend out of pocket on covered Part D prescriptions in 2026. Your monthly plan premium does not count toward the cap. Drugs your plan does not cover do not count either, which is why it pays to check a plan's formulary before you enroll.

Once you cross that $2,100 threshold, you are done paying for covered drugs for the calendar year, according to CMS Part D program rules.

The Medicare Prescription Payment Plan

New in 2025 and continuing in 2026, every Part D plan must offer the Medicare Prescription Payment Plan. This is an optional program that lets you spread your drug costs into monthly payments across the year instead of paying a large amount at the pharmacy counter.

It does not lower your total costs — you still pay the same amount overall — but it can make big pharmacy bills easier to manage, especially early in the year when you are working through the deductible. You have to opt in; you can do that through your plan.

Higher-income enrollees and IRMAA

Most people pay only their plan's premium for Part D. But if your income is above a certain level, Medicare adds a surcharge called IRMAA (Income-Related Monthly Adjustment Amount) on top of your Part D premium. For 2026, IRMAA kicks in above $109,000 in income for a single filer (and higher for joint filers). Social Security uses your tax return from two years earlier to decide.

If your income has dropped since then — because of retirement, for example — you can ask Social Security to reconsider.

Part D availability around Webster Groves

Webster Groves is in St. Louis County, where Medicare beneficiaries can compare stand-alone Part D drug plans as well as Medicare Advantage plans that include drug coverage. Plan availability, formularies, and pharmacy networks are set at the county level, so the exact list of options depends on your ZIP code and county, not the city itself.

The best way to see what is available for your address is the Plan Finder at medicare.gov, which lets you enter your prescriptions and see how each plan would handle them.

Key dates to remember

• Oct. 15 – Dec. 7: Medicare Annual Enrollment Period. Join, switch, or drop a Part D plan for the following year.
• Jan. 1 – Mar. 31: Medicare Advantage Open Enrollment. If you are in a Medicare Advantage plan, you can switch to another Advantage plan or return to Original Medicare (and pick up a stand-alone Part D plan).
• Special Enrollment Periods may apply if you move, lose other coverage, or qualify for Extra Help.