Medicare Part D

Part D in 2026: What the New $2,100 Cap Means for You

TUKWILA, Wash. — If you take prescription drugs and have Medicare, 2026 brings the biggest change to Part D in years. There is now a firm yearly limit on what you pay out of pocket for covered drugs — $2,100 — and the old "donut hole" is gone for good. Here is what the coverage looks like this year, in plain terms.

How Part D works in 2026

Part D is the part of Medicare that helps pay for prescription drugs you pick up at the pharmacy. It is offered through private plans that Medicare approves, either as a stand-alone drug plan or built into a Medicare Advantage plan.

In 2026, every Part D plan follows the same basic structure set by Medicare, even though the specific drugs covered and the copay amounts vary from plan to plan. That structure has three phases, and once you hit the yearly cap, you are done paying for covered drugs for the rest of the year.

Phase 1: The deductible

This is what you pay first, before your plan starts sharing the cost. In 2026, the maximum deductible a Part D plan can charge is $615, according to CMS. Plans are allowed to set a lower deductible — some charge nothing at all for certain drug tiers — but no plan can go higher than $615.

Once you have paid the deductible (if your plan has one), you move into the next phase.

Phase 2: Initial coverage

In this phase, you and your plan share the cost of your drugs. You usually pay a copay (a set dollar amount) or coinsurance (a percentage) each time you fill a prescription. What you pay depends on which "tier" the drug falls into on your plan's list of covered drugs, called a formulary.

Every dollar you spend out of pocket in this phase counts toward the $2,100 yearly cap.

Phase 3: Catastrophic coverage

Once your out-of-pocket costs for covered drugs reach $2,100 for the year, you enter catastrophic coverage. In this phase, you pay $0 for the rest of the calendar year on drugs your plan covers. This is the hard cap Congress created in the Inflation Reduction Act, and 2026 is the second year it is in effect at this dollar level.

Before 2025, there was a fourth phase called the coverage gap, or "donut hole," where costs could jump unexpectedly. That phase no longer exists.

The Medicare Prescription Payment Plan

If your drug costs are high early in the year, hitting the deductible or a big copay all at once can sting. Medicare now offers an option called the Medicare Prescription Payment Plan. It lets you spread your out-of-pocket drug costs across monthly payments over the calendar year instead of paying the pharmacy in full each time.

It does not lower your total costs, and it does not change what your plan covers — it just smooths the timing. You have to opt in through your Part D plan. You can learn more at medicare.gov.

A quick note on Tukwila

Tukwila is in King County, where Medicare beneficiaries can choose from a wide selection of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. Plan availability, formularies, and pharmacy networks are set at the county level, so two neighbors in Tukwila will see the same menu of plans — but the right fit depends on the specific drugs each person takes.

For free, unbiased help comparing what is available, Washington residents can contact the state's SHIP program (called SHIBA here) or use the Plan Finder tool at medicare.gov.

Key dates to remember

The Annual Enrollment Period runs October 15 through December 7 each year. That is when you can join, switch, or drop a Part D plan for the following year. If you are in a Medicare Advantage plan, you also have the Medicare Advantage Open Enrollment Period from January 1 through March 31 to make a one-time change.

Higher-income beneficiaries should also know that IRMAA surcharges — extra amounts added to Part B and Part D premiums — begin above $109,000 in income for a single filer in 2026.