Quick answer: Medicare Part D is prescription drug coverage sold by private insurers. In 2026, once your out-of-pocket drug costs hit $2,100, covered prescriptions cost $0 for the rest of the year — there’s no more “coverage gap.”
How Part D Works
You get Part D either through a standalone drug plan (if you have Original Medicare) or bundled into your Medicare Advantage plan. You’ll pay a monthly premium that varies by plan, plus copays or coinsurance based on your drug’s tier.
The Big 2026 Change: A $2,100 Cap
The old “donut hole” coverage gap is gone. In 2026, your out-of-pocket drug spending is capped at $2,100 — once you hit it, covered prescriptions are $0 for the rest of the calendar year. See the full 2026 cost breakdown.
The Insulin Cap
No matter what phase you’re in, covered insulin costs no more than $35 for a month’s supply, with no deductible applied.
Avoiding the Late Enrollment Penalty
Going 63 days or more without Part D or other creditable drug coverage adds a permanent penalty to your premium. See how it’s calculated — and how Extra Help recipients are exempt entirely.
Help If You Have Limited Income
Extra Help can significantly lower your premium, deductible, and copays if you qualify based on income and resources. See if you qualify.
Frequently Asked Questions
Do I have to get Part D if I don’t take any medications now?
You’re not required to, but delaying without other creditable drug coverage risks a permanent late enrollment penalty later, even if you don’t need drugs today.
Is the “donut hole” still a thing?
No. As of 2026, the coverage structure is simply deductible, then coinsurance, then a $2,100 out-of-pocket cap — the old coverage gap phase has been eliminated.
Can I change my Part D plan every year?
Yes, during the Annual Enrollment Period (October 15 – December 7), you can switch to a different Part D plan for the following year.
