Part D Prescription Drug Plans

Medicare Part D helps cover prescription drug costs. If you are becoming eligible for Medicare at age 65, your Initial Enrollment Period generally lasts 7 months - beginning 3 months before the month you turn 65, including the month you turn 65, and ending 3 months afterward. If you are under 65 and eligible for Medicare, you may also be eligible for Part D.

It’s important to enroll on time or maintain creditable prescription drug coverage from another source, such as qualifying employer or retiree coverage. If you go 63 consecutive days or more without Medicare drug coverage or other creditable prescription drug coverage after your Initial Enrollment Period, you may have to pay a Part D late enrollment penalty for as long as you have Part D coverage.

If you are already enrolled in a standalone Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage, you can change plans during the Medicare Open Enrollment Period, which runs from October 15 through December 7 each year.

How Part D works in 2026

In 2026, your out-of-pocket spending on covered Part D drugs is capped at $2,100. Once you reach this threshold, you pay $0 for covered Part D drugs for the remainder of the calendar year.

The maximum Part D deductible is $615 in 2026, although some plans have a lower deductible or no deductible. Your specific deductible and cost sharing will depend on the plan you choose.

Part D drug coverage generally has three stages:

• Annual deductible: If your plan has a deductible, you pay out-of-pocket costs for covered drugs subject to the deductible until it is met.
• Initial coverage: After you meet your deductible, the standard Part D benefit generally has you pay 25% coinsurance for covered generic and brand-name drugs until your out-of-pocket spending reaches $2,100 in 2026. Actual copayments and coinsurance may vary by plan.
• Catastrophic coverage: Once you reach the $2,100 out-of-pocket threshold, you pay $0 for covered Part D drugs for the rest of the calendar year.

These changes are part of the Medicare Part D benefit redesign established under the Inflation Reduction Act and are intended to make prescription drug costs more predictable.

Choosing a plan

It pays to review your Part D coverage every year, particularly if you have started taking new medications. Plan formularies, premiums, deductibles, pharmacy networks, and cost sharing can change from year to year.

Start at Medicare.gov, where you can learn more about Medicare prescription drug coverage and use the Medicare Plan Compare tool. Enter your prescriptions and preferred pharmacies to compare how different plans cover your medications.

Getting financial help

People with limited income and financial resources may qualify for Extra Help, a Medicare program that helps pay Part D premiums and out-of-pocket prescription drug costs.

In 2026, individuals with annual income below $23,940 and financial resources below $18,090, or married couples with annual income below $32,460 and financial resources below $36,100, may qualify for Extra Help. Certain income and resource exclusions apply, and income limits are higher in Alaska and Hawaii.

Learn more and apply for Medicare Part D Extra Help through the Social Security Administration, or call Stellar Health Agency for help reviewing your options.