Medicare Part D

Before fall enrollment: how Part D works in 2026

# A plain-language guide to Medicare prescription drug…

DRAPER, Utah — If you take prescription drugs and have Medicare, the way you pay for those medicines is changing in ways worth understanding. In 2026, Medicare Part D — the part of Medicare that helps cover prescription drugs — keeps the redesigned structure that started in 2025. That means no more "donut hole," a firm yearly cap on what you pay out of pocket, and just three phases to track instead of four.

Here is a plain-language look at how Part D will work in 2026, so you can walk into the fall enrollment window knowing what to look for.

What Part D is, in one paragraph

Part D is the prescription drug piece of Medicare. It is sold by private insurance companies that Medicare approves. You can get it as a stand-alone drug plan added to Original Medicare, or as part of a Medicare Advantage plan that bundles medical and drug coverage together. Draper is in Salt Lake County, where multiple companies offer Part D coverage — the specific number changes each year during the Annual Enrollment Period.

Phase 1: The deductible

The first phase is the deductible. This is the amount you pay yourself before the plan starts sharing costs. For 2026, no Part D plan can charge a deductible higher than $615. Some plans set it lower, and some do not charge one on certain tiers of drugs. Once you have paid the deductible amount for covered drugs, you move into the next phase.

Phase 2: Initial coverage

In the initial coverage phase, you and your plan share the cost of your prescriptions. You usually pay a copay (a flat dollar amount) or coinsurance (a percentage) each time you fill a prescription. The exact split depends on the plan's formulary — the list of drugs it covers and what tier each drug falls on.

You stay in this phase until what you have paid out of pocket for the year reaches the annual cap.

Phase 3: Catastrophic coverage — and the $2,100 cap

Here is the big change readers keep asking about. Starting in 2025 and continuing in 2026, once your out-of-pocket spending on covered Part D drugs hits $2,100, you pay $0 for the rest of the calendar year on those covered drugs. That is the catastrophic phase, and it is the ceiling that used to not exist.

Before 2025, there was a fourth phase called the coverage gap — the "donut hole" — where your share of costs went up in the middle of the year. That phase is eliminated. Now it is just three: deductible, initial coverage, catastrophic.

The Medicare Prescription Payment Plan

Even with the cap, $2,100 in January is a lot harder to handle than $2,100 spread over 12 months. That is why Medicare offers the Medicare Prescription Payment Plan. If you opt in, your plan bills your drug costs monthly instead of all at the pharmacy counter. It does not lower what you owe, and there is no extra fee to use it — it simply smooths the timing. You can sign up through your Part D plan.

A note on higher incomes (IRMAA)

Most people pay only their plan's premium. But if your income is above $109,000 as a single filer (based on your 2024 tax return for 2026 premiums), you will pay an income-related surcharge called IRMAA on top of the plan premium. Social Security notifies you by mail if this applies. The thresholds are set by CMS and adjust each year.

When you can make changes

Two windows matter most:

• Annual Enrollment Period: October 15 through December 7. This is when anyone with Medicare can join, switch, or drop a Part D or Medicare Advantage plan for the following year.
• Medicare Advantage Open Enrollment: January 1 through March 31. If you are already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare (and pick up a stand-alone Part D plan).

If you qualify for Extra Help (a low-income subsidy) or have another Special Enrollment Period, you may be able to make changes at other times.

How to decide what fits

A good Part D fit is really a match between three things: the drugs you take, the pharmacies you use, and the plan's formulary and network. The Plan Finder at medicare.gov lets you enter your prescriptions and ZIP code and see how each plan available in Salt Lake County would handle them. Your local State Health Insurance Assistance Program (SHIP) — called Utah SHIP here — offers free, unbiased counseling.