Medicare Part D in 2026: What Changed and Why It Matters

Part D is Medicare's prescription drug coverage. It's optional, but skipping it when you're first eligible triggers a permanent late-enrollment penalty, so almost everyone should have it in some form. The good news is that Part D got a lot better recently, and most people haven't heard.

The donut hole is gone

For years, Part D had a coverage gap where you paid a big share of drug costs until you reached a catastrophic threshold. That gap was eliminated in 2025. Now every Part D plan has a hard annual cap on what you pay out of pocket for covered drugs: $2,100 for 2026. Once you reach it, your covered prescriptions are $0 for the rest of the year.

You can spread costs over the year

The Medicare Prescription Payment Plan lets you split your out-of-pocket drug costs into monthly payments instead of paying a large amount at the pharmacy in January. It's optional, and it's worth a look if you take an expensive brand-name medication.

How to choose a plan

• Start with your drug list, not the premium. A $0-premium plan that puts your medication on tier 4 will cost more than a $30 plan that has it on tier 2.

• Check the pharmacy. Preferred pharmacies have lower copays, and the list differs by plan.

• Look at the deductible. Some plans waive it for generics; others apply it to everything.

• If you're on Medicare Advantage, your drug coverage is probably built in. Compare the whole package, not just the drug piece.

Extra Help

If your income and assets are limited, the Extra Help program can lower or eliminate your Part D premiums, deductibles, and copays. I check eligibility as part of every plan review. It's underused in Ocean County and it's worth thousands to the people who qualify.

Bring me your prescription list and I'll run it against every plan available in your zip code. Call (732) 554-3021 or book a free consultation.