Medicare Part D
How the Part D $2,100 Cap Works in Mount Vernon
MOUNT VERNON, Wash. — Starting Jan. 1, 2026, Medicare Part D has a firm ceiling on what enrollees pay out of pocket for covered prescription drugs: $2,100 for the year. Once you hit that number at the pharmacy counter, your covered Part D medications cost you nothing more for the rest of the calendar year.
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Key takeaways
- Starting Jan. 1, 2026, Medicare Part D out-of-pocket costs for covered drugs are capped at $2,100 for the year, up from $2,000 in 2025.
- The Part D deductible can be up to $615 in 2026, and this amount counts toward the $2,100 cap.
- The old coverage gap, or "donut hole," is gone, leaving Part D with just three phases: deductible, initial coverage, and catastrophic coverage.
- Enrollees can opt into the free Medicare Prescription Payment Plan to spread out-of-pocket drug costs into monthly payments instead of paying it all at the pharmacy.
If you take expensive medications — or you've ever landed in what people used to call the "donut hole" — this is one of the biggest changes to Medicare in years. Here's what to know before, during, and after the Annual Enrollment Period, which runs Oct. 15 through Dec. 7.
The $2,100 cap, in plain English
For 2026, the most you'll pay out of pocket for covered Part D drugs is $2,100, up slightly from the $2,000 cap that took effect in 2025. That cap applies whether you get your drug coverage through a standalone Part D plan or through a Medicare Advantage plan that includes drugs.
A few things the cap does not include:
- Your monthly Part D premium.
- Drugs your plan doesn't cover (non-formulary drugs).
- Medications billed under Part B, such as many drugs given in a doctor's office.
The Part D annual deductible can be up to $615 in 2026. Plans can set a lower deductible, but not a higher one. That deductible amount counts toward your $2,100 cap.
The coverage gap is gone
For years, Part D had four phases, and the third one — the coverage gap, better known as the donut hole — was where people got hit with surprise costs.
That phase was eliminated in 2025 and remains gone in 2026. Part D now has just three phases: the deductible, the initial coverage phase, and catastrophic coverage. Once your out-of-pocket spending reaches $2,100, you're in catastrophic coverage, and you pay $0 for covered drugs for the rest of the year.
This is a real structural change, not a marketing headline. It's set by CMS under the Inflation Reduction Act and applies to every Part D plan.
The Medicare Prescription Payment Plan: smoothing the bill
Even with a $2,100 cap, hitting that number early in the year can sting. A single expensive prescription in January could mean a big pharmacy bill right after the holidays.
That's where the Medicare Prescription Payment Plan comes in. It's a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying the full amount at the pharmacy.
A few things to understand before opting in:
- It doesn't save you money — you still owe the same total. It just changes when you pay.
- You pay $0 at the pharmacy for covered drugs; the plan bills you monthly.
- It works best for people with high or unpredictable drug costs, especially early in the year.
- You can sign up at any time through your Part D plan.
If you fill mostly low-cost generics, this program may add paperwork without much benefit. If one of your prescriptions runs into the hundreds of dollars, it's worth a look.
What this means locally
Mount Vernon is in Skagit County, where Medicare beneficiaries can choose between Original Medicare paired with a standalone Part D plan, or a Medicare Advantage plan that includes drug coverage. The $2,100 cap and the payment plan option apply either way — they're federal rules, not plan features.
For a full list of Part D and Medicare Advantage plans available in Skagit County, use the Plan Finder at medicare.gov and enter your ZIP code.
Common mistakes to avoid this fall
- Assuming your current plan's drug list (formulary) stays the same. Formularies change every year. Check your plan's Annual Notice of Change, which arrives in September.
- Skipping the review because "nothing changed for me." Your medications, prices, and pharmacy network can all shift year to year, even if your health didn't.
- Confusing the $2,100 cap with a premium cap. Premiums are separate and vary by plan.
- Missing the Dec. 7 deadline. Changes made during AEP take effect Jan. 1, 2026. There's also a Medicare Advantage Open Enrollment Period from Jan. 1 to March 31, but it has narrower rules.
- Forgetting IRMAA. Higher-income enrollees pay a surcharge on Part B and Part D premiums. For 2026, IRMAA generally starts above $109,000 in income for a single filer, based on your 2024 tax return.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Skagit County
(MA penetration in Skagit County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Prescription coverage
How Medicare Part D works in 2026
The old coverage gap (“donut hole”) is eliminated as of 2025 (three phases now). There’s now a hard yearly cap of $2,100 on what you pay out of pocket for covered drugs, and you can spread those costs across the year with the Medicare Prescription Payment Plan.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Does the $2,100 cap reset every year?
Do insulin and vaccines count toward the cap?
If I sign up for the payment plan, can I cancel?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.