Medicare Part D

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

PORT ANGELES, Wash. — If you take prescription drugs and have Medicare, 2026 brings some real clarity to Part D. There's a new, lower out-of-pocket cap. The old "donut hole" is gone. And you can spread your drug costs across the year if that helps your budget.

Port Angeles readers: here's how Part D will work in 2026

Here's a plain-language look at how Part D works in 2026, and where to get help locally.

The three phases of Part D in 2026

For years, Part D had four confusing phases, including the dreaded coverage gap. As of 2025, that gap is gone. In 2026, your Part D coverage moves through three phases:

1. Deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible. In 2026, the maximum deductible any Part D plan can charge is $615. Some plans set a lower deductible, and some drugs may be covered before you hit it. 2. Initial coverage phase. After the deductible, you pay a copay or coinsurance for each prescription, and your plan pays the rest. You stay in this phase until your total out-of-pocket spending on covered drugs reaches the yearly cap. 3. Catastrophic phase. Once you hit the out-of-pocket cap, you pay $0 for covered Part D drugs for the rest of the calendar year.

The $2,100 out-of-pocket cap

This is the headline change readers keep asking about. In 2026, the most you can pay out of pocket for covered Part D prescriptions in a calendar year is $2,100. Once you reach that number, your covered drugs are paid in full through the end of the year.

A few things to know:

• The cap counts what you pay for covered drugs — not what your plan pays.
• Premiums do not count toward the cap.
• Drugs that aren't on your plan's formulary don't count toward it either.

The cap resets every January 1.

The Medicare Prescription Payment Plan

If a big pharmacy bill early in the year would be hard to handle, Medicare now offers an option called the Medicare Prescription Payment Plan. Instead of paying the pharmacy at pickup, you can spread your covered out-of-pocket drug costs into monthly payments across the calendar year.

It doesn't lower your total costs, and it's not automatic — you have to opt in through your Part D or Medicare Advantage drug plan. For some people it smooths out the budget; for others it isn't needed. Medicare.gov has a worksheet that can help you decide.

What Port Angeles residents should know locally

Port Angeles is in Clallam County, and that's where Medicare plan availability is set. Whether you get Part D through a stand-alone drug plan or bundled into a Medicare Advantage plan, the choices on your Medicare.gov Plan Finder are based on your Clallam County ZIP code.

The 2026 program rules — the $615 maximum deductible, the $2,100 cap, and the three phases — are the same everywhere in the country. What changes by county is which plans, pharmacies, and formularies are available to you.

For free, unbiased help comparing your options, Washington's SHIBA program (the State Health Insurance Benefits Advisors — Washington's SHIP) has local volunteers who can sit down with you. They don't sell plans.

Higher-income enrollees: a quick note on IRMAA

If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may pay an IRMAA surcharge on top of your Part D premium in 2026. Social Security will notify you if it applies. You can appeal if your income has dropped due to a life event like retirement.

Key dates to circle

• Oct. 15 – Dec. 7, 2025: Medicare Annual Enrollment Period. This is when you can join, switch, or drop a Part D plan for 2026.
• Jan. 1 – March 31, 2026: Medicare Advantage Open Enrollment. If you're in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare (and pick up a stand-alone Part D plan).