Medicare Part D

Part D in Kettering: $2,100 cap, no more coverage gap

KETTERING, Ohio — With the Medicare Annual Enrollment Period running through Dec. 7, people on Medicare here in Montgomery County are taking a fresh look at their drug coverage. Part D is changing in ways that matter for 2026, and the biggest shift is a hard ceiling on what you pay out of pocket for covered prescriptions.

Here is a plain-English guide to how Part D works in 2026 — the deductible, the new $2,100 cap, and the three phases your costs move through during the year.

The deductible phase

Part D starts with a deductible. In 2026, no Part D plan can charge a deductible higher than $615, according to CMS. Some plans set it lower, and some set it at zero. Until you meet your plan's deductible, you generally pay the full negotiated price for your covered drugs.

If your plan has no deductible, you skip this phase and go straight to initial coverage.

The initial coverage phase

Once the deductible is met, you enter initial coverage. Here, you pay a copay or coinsurance for each prescription, and your plan pays the rest. The exact share depends on the plan and the drug's tier.

This phase continues until the total you have paid out of pocket for covered drugs reaches the annual cap.

The catastrophic phase — and the $2,100 cap

This is the big one for 2026. Once your out-of-pocket costs on covered Part D drugs hit $2,100, you are done paying for those drugs for the rest of the calendar year. You move into the catastrophic phase, and your cost share drops to $0 for covered prescriptions.

That cap is set by Medicare and applies across all Part D plans, whether you have a stand-alone drug plan or drug coverage built into a Medicare Advantage plan. The coverage gap — what people used to call the "donut hole" — was eliminated in 2025, so 2026 keeps the simpler three-phase structure: deductible, initial coverage, catastrophic.

Smoothing the cost across the year

Even with the $2,100 cap, a big pharmacy bill in January can sting. That is where the Medicare Prescription Payment Plan comes in. It lets you spread your out-of-pocket drug costs across the remaining months of the year in level monthly payments, instead of paying the pharmacy all at once.

There is no extra fee to use it, and it is optional. You sign up through your Part D plan. It does not lower your total cost — it just reshapes when you pay.

What Kettering readers should watch

Kettering is in Montgomery County, where residents can compare Part D plans and Medicare Advantage plans with drug coverage during Annual Enrollment, Oct. 15 through Dec. 7. Changes you make take effect Jan. 1, 2026.

A couple of other 2026 details worth knowing:

• Higher-income surcharges (IRMAA): If your 2024 income was above $109,000 as a single filer (or $218,000 filing jointly), you may pay an income-related surcharge on top of your Part D premium in 2026.
• Formularies change every year. Even if you like your current plan, check that your prescriptions are still covered and still on the same tier for 2026.

If you want one-on-one help, Ohio's State Health Insurance Assistance Program (SHIP) — called OSHIIP — offers free, unbiased counseling. You can also call 1-800-MEDICARE or compare plans at medicare.gov.