Medicare Part D

Medicare Part D in 2026: The New $2,100 Cap Explained

WESTERLY, R.I. — If you take prescription drugs and have Medicare, 2026 brings one of the biggest changes to Part D in years: a firm $2,100 yearly limit on what you pay out of pocket for covered drugs at the pharmacy. Here's how the program works now, in plain language, for readers here in Washington County.

The big change: a hard $2,100 cap

Starting in 2026, once your out-of-pocket spending on covered Part D drugs reaches $2,100 for the year, you pay $0 for the rest of your covered prescriptions through December 31. This cap replaces the old "donut hole" system that used to leave people paying thousands before catastrophic coverage kicked in.

The cap resets every January 1, so the clock starts over each new plan year.

The deductible: up to $615

Before your plan starts sharing costs, you may have to pay a deductible. For 2026, the maximum Part D deductible is $615. Plans can charge less than that — some charge nothing at all on certain drug tiers — but no Part D plan can charge more than $615.

The deductible amount and which drugs it applies to vary by plan, so it's worth checking your plan's formulary before filling a new prescription.

The three phases of Part D in 2026

With the donut hole gone as of 2025, Part D now has just three phases:

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. You and your plan share costs — usually through copays or coinsurance — until your out-of-pocket spending reaches $2,100. 3. Catastrophic phase. Once you hit $2,100, you pay $0 for covered drugs for the rest of the calendar year.

This is a much simpler structure than what Medicare beneficiaries navigated for nearly two decades.

Smoothing your costs: the Medicare Prescription Payment Plan

If you're worried about a big pharmacy bill early in the year — say, a $600 charge in January before you've hit the cap — you can opt into the Medicare Prescription Payment Plan. This free program lets you spread your out-of-pocket drug costs across monthly payments instead of paying all at once at the counter.

It doesn't lower what you owe overall, but it can make cash flow easier. You sign up through your Part D plan, and you can join anytime during the year.

Higher-income surcharges (IRMAA)

Most people pay only their plan's premium. But if your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you'll owe an extra amount called IRMAA on top of your Part D premium. Social Security notifies you if it applies and takes it directly from your benefit check.

What Westerly residents should know locally

Westerly is in Washington County, where Part D plan availability is set at the county level by the Centers for Medicare & Medicaid Services. That means the same menu of stand-alone Part D plans and Medicare Advantage plans with drug coverage available in Wakefield or Narragansett is available here. Formularies, pharmacy networks, and premiums vary from plan to plan, so comparing options on Medicare.gov's Plan Finder is the most reliable way to see what fits your prescriptions.

Key dates to remember

• October 15 – December 7: Annual Enrollment Period. You can join, switch, or drop a Part D or Medicare Advantage plan.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in an MA plan, you can switch once or return to Original Medicare.