Medicare Part D

Your Part D Drug Costs Stop at $2,100 in 2026 — Here's How

CHARLOTTE, N.C. — If you take prescription drugs and have Medicare, 2026 brings a change worth understanding before you pick up your next refill. Medicare Part D — the part of Medicare that covers prescription drugs — now has a firm ceiling on what you can pay out of pocket in a single year. Once your spending hits $2,100, you're done paying for covered drugs for the rest of the year.

That cap, along with a simpler three-phase structure, is reshaping how drug coverage works for people on Medicare across Mecklenburg County and the rest of the country. Here's a plain walk-through.

The three phases of Part D in 2026

Since 2025, Part D has three phases instead of four. The confusing "coverage gap" (often called the donut hole) is gone. Here's what's left:

1. Deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible. In 2026, no Part D plan can charge a deductible higher than $615. Some plans use a lower deductible, and some drugs may be covered before you meet it.

2. Initial coverage phase. After the deductible, you pay a copay or coinsurance for each prescription while 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 the $2,100 cap, you pay $0 for covered Part D drugs for the rest of the calendar year.

What the $2,100 cap actually covers

The cap applies to what you spend out of pocket on Part D covered drugs — your deductible and your copays or coinsurance count toward it. Your monthly Part D premium does not count toward the cap. Drugs given in a doctor's office or hospital, which are usually billed under Part B rather than Part D, also don't count here.

The cap resets every January 1.

The Medicare Prescription Payment Plan

If paying for an expensive prescription all at once is hard on your budget, there's a newer option worth knowing about. The Medicare Prescription Payment Plan lets you spread your Part D drug costs across the calendar year in monthly installments, instead of paying the full amount at the pharmacy counter.

It's free to sign up, and it doesn't lower your total cost — it just smooths the timing. You can opt in through your Part D plan or your Medicare Advantage plan that includes drug coverage. For people who fill high-cost prescriptions early in the year, this can make cash flow much easier.

How Part D is offered in Charlotte

Charlotte is in Mecklenburg County, where Part D coverage is available two ways: as a stand-alone prescription drug plan you pair with Original Medicare, or built into a Medicare Advantage plan. The specific plans, drug lists (called formularies), and pharmacy networks vary, so it's worth comparing options during Annual Enrollment.

You can see every plan offered in your ZIP code using the Plan Finder tool at medicare.gov.

Enrollment dates to remember

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

If you're new to Medicare, you have an Initial Enrollment Period tied to your 65th birthday.

A note on higher-income households

If your income is above $109,000 as a single filer (or $218,000 filing jointly), you may pay an IRMAA surcharge on top of your Part D premium. Social Security uses your tax return from two years earlier to decide. If your income has dropped since then — say, because you retired — you can ask Social Security to reconsider.