Medicare Part D

Medicare's New $2,100 Drug Cap Starts in 2026: What Tacoma Should Know

Tacoma, Wash. — Starting Jan. 1, 2026, people with Medicare Part D will have something they've never had before: a firm yearly limit on what they pay out of pocket for covered prescription drugs. That ceiling is $2,100. Once you hit it, you pay nothing more for covered drugs for the rest of the calendar year.

For Tacoma residents choosing coverage during this fall's Annual Enrollment Period (Oct. 15 – Dec. 7), the change is one of the biggest shifts in Part D since the benefit began.

The $2,100 cap, in plain English

Under Medicare's rules for 2026, your out-of-pocket costs for covered Part D drugs — that means your deductible, copays, and coinsurance — can't add up to more than $2,100 in a single year. After that, the plan and Medicare pick up the rest.

A few things to keep in mind:

• The $2,100 cap only applies to drugs your plan covers. If a medicine isn't on your plan's formulary, what you pay for it doesn't count.
• Part D plans can still charge a deductible in 2026, up to a maximum of $615.
• The cap resets every January.

This applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan that includes drug benefits.

Goodbye, "donut hole"

If you've had Medicare for a while, you probably remember the coverage gap — the "donut hole" — where your share of drug costs jumped after you hit a certain spending level, then dropped again once you reached catastrophic coverage.

That gap was closed in 2025. In 2026, Part D has just three phases:

1. Deductible (if your plan has one — up to $615). 2. Initial coverage — you pay a share of the cost until you hit $2,100 out of pocket. 3. Catastrophic coverage — you pay $0 for covered drugs the rest of the year.

That's it. No more sudden price spikes mid-year because you crossed into the gap.

The Medicare Prescription Payment Plan

Even with a $2,100 cap, $2,100 all at once — or in the first couple of months of the year, if you take an expensive medication — can be hard on a budget.

That's why Medicare offers the Medicare Prescription Payment Plan. It's a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying at the pharmacy counter.

A few things worth knowing:

• It doesn't lower what you owe overall — it just smooths the timing.
• You still pick up your prescriptions the same way; the plan bills you monthly.
• You can sign up before the year starts or at any point during the year, though signing up earlier gives you more months to spread payments across.
• You opt in through your Part D or Medicare Advantage drug plan, not through Medicare directly.

For people with high-cost drugs in January or February, this can be the difference between filling a prescription and putting it off.

What this means for Tacoma

Tacoma sits in Pierce County, and like the rest of Washington, Part D coverage here is offered through private insurance companies approved by Medicare. The federal rules — the $2,100 cap, the $615 deductible ceiling, the three-phase design, and the payment plan option — apply the same way in Pierce County as they do anywhere else in the country.

What varies locally is which specific plans are sold, which pharmacies are in-network, and which drugs each plan covers. That's why comparing plans on your actual medication list matters more than picking based on a premium alone.

You can compare the Part D and Medicare Advantage plans available in your ZIP code using the Plan Finder at medicare.gov.

Higher earners: don't forget IRMAA

If your income is above certain thresholds, you pay an income-related monthly adjustment amount (IRMAA) on top of your Part B and Part D premiums. For 2026, IRMAA begins above $109,000 for a single filer (and higher for joint filers). Social Security uses your tax return from two years earlier to determine whether it applies.

The $2,100 out-of-pocket cap still protects you either way — IRMAA affects premiums, not the cap.

Key dates to circle

• Oct. 15 – Dec. 7, 2025: Medicare Annual Enrollment Period. Join, switch, or drop Part D and Medicare Advantage plans for 2026.
• Jan. 1, 2026: New Part D rules take effect, including the $2,100 cap.
• Jan. 1 – Mar. 31, 2026: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you get one chance to switch to another Advantage plan or return to Original Medicare.