Medicare Supplement
Lexington Medicare Guide to the 2026 Part D Cap
LEXINGTON, Ky. — If you take prescription drugs and have Medicare, 2026 brings some of the clearest changes to Part D in years. There's a firm new ceiling on what you'll pay out of pocket, a set maximum deductible, and the old "donut hole" is gone. Here's what people in Lexington and across Fayette County should know before the plan year begins.
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Click to call 855-729-3240Key takeaways
- In 2026, Part D out-of-pocket spending on covered drugs is capped at $2,100 per year, after which you pay $0 for the rest of the year.
- Part D plans can charge a deductible, but it cannot be more than $615 for the year, and some plans set it lower or at zero.
- The old "donut hole" coverage gap is gone, leaving three phases: deductible, initial coverage, and catastrophic.
- The optional, free Medicare Prescription Payment Plan lets you spread your Part D out-of-pocket costs into monthly payments instead of paying it all at the pharmacy.
The big headline: a $2,100 out-of-pocket cap
In 2026, the most you'll pay out of pocket for covered prescription drugs under Part D is $2,100 for the year, according to CMS. Once your out-of-pocket spending on covered drugs hits that number, you pay $0 for the rest of the calendar year on those drugs.
That cap applies whether your Part D coverage comes through a stand-alone Prescription Drug Plan or is built into a Medicare Advantage plan that includes drug coverage.
The deductible: up to $615
Part D plans can charge a deductible before cost-sharing kicks in. For 2026, the maximum allowed deductible is $615. Plans can set theirs lower — some set it at zero — but no Part D plan can charge more than that amount for the year.
The deductible, if your plan has one, is the first thing you work through when you fill prescriptions in January.
The three phases of Part D in 2026
Since 2025, the coverage gap (the old "donut hole") has been eliminated. That leaves three phases in a Part D plan year:
1. Deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible (up to $615). 2. Initial coverage phase. You and your plan share costs — typically a copay or coinsurance for each prescription — until your out-of-pocket spending reaches $2,100. 3. Catastrophic phase. Once you hit the $2,100 cap, you pay $0 for covered Part D drugs for the rest of the year.
This is a simpler structure than Medicare used for years, and it puts a hard ceiling on annual drug costs — which is a real change for people with expensive medications.
The Medicare Prescription Payment Plan
There's also a tool called the Medicare Prescription Payment Plan. It doesn't lower your drug costs, but it lets you spread your out-of-pocket Part D costs across the calendar year in monthly payments instead of paying a large amount at the pharmacy counter.
Participation is optional and free to sign up for. It can be especially helpful if you'd otherwise face a big bill early in the year — for instance, if you hit your deductible in January or February. You can ask your Part D plan how to enroll.
A note on higher-income enrollees (IRMAA)
Most people pay the standard Part D premium set by their plan. But if your income is above a certain level, Medicare adds an income-related monthly adjustment amount (IRMAA) on top. For 2026, IRMAA on Part D begins for single filers with income above $109,000 (higher thresholds apply to joint filers). Social Security notifies you if it applies to you.
What's available in Lexington
Lexington is in Fayette County, where Medicare plan options — including stand-alone Part D plans and Medicare Advantage plans with drug coverage — are set at the county level. To see the current count of plans and carriers available in Fayette County for 2026, use the Plan Finder at Medicare.gov, which lets you compare plans by your specific drug list and preferred pharmacy.
Key dates to remember
- Annual Enrollment Period: October 15 – December 7 (choose or change Part D and Medicare Advantage coverage for the next year).
- Medicare Advantage Open Enrollment: January 1 – March 31 (if you're already in a Medicare Advantage plan, you can make one change).
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 Fayette County
(MA penetration in Fayette 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.
Explore
The parts of Medicare
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
Q: If I hit the $2,100 cap in, say, August, do I really pay nothing for the rest of the year?
Q: Does the $2,100 cap include my monthly plan premium?
Q: What happened to the donut hole?
- CMS — Medicare basics (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.