Medicare Part D provides prescription drug coverage through private plans with $2,100 out-of-pocket maximum (2026). No donut hole, $615 max deductible, average $35/month premium. After $2,100 OOP spend, covered drugs cost $0 for the year — applies to PDPs and MA-PD plans.
Medicare Part D: Prescription Drug Coverage Complete Guide
Medicare Part D ($2,100 Cap):
- Deductible Phase: $0–$615 max → You pay 100%
- Initial Coverage (to Cap): $615–$2,100 OOP → Co-Pays Vary by plan
- Post-Cap: $2,100+ OOP → $0 for covered Part D drugs rest of year
NOTE: Medicare Prescription Payment Plan — you can spread the $2,100 cap across 12 monthly payments instead of paying upfront at pharmacy.
What Part D Covers (Formulary Limited)
Tier 1 Generic: $2–$10 copay
Tier 2 Preferred: $15–$30 copay
Tier 3-5: 25-50% coinsurance until $2,100 cap
NOT Covered: OTC, vitamins, non-formulary drugs, cosmetics
Part D Late Enrollment Penalty (Permanent)
Penalty: 1% × $38.99 base = $0.39/month per uncovered month. Example: 24 months late is $9.36/month added to EVERY Part D plan forever
Avoid: Enroll Oct 15–Dec 7 in Part C or Part D plan OR prove creditable coverage after you stop working.
Enrollment Deadlines (Annual)
Open Enrollment: Oct 15–Dec 7 → Jan 1 coverage
Initial Enrollment: 65th birthday ± 3 months
Extra Help (Low-Income): $0–$11/month, $0 deductible/copays
Find a Prescription Drug Plan That Works for You
Medicare Part D plans vary by location, pharmacy network, covered medications, and cost. Formularies, deductibles, and copays can change each year, making it important to review your options carefully. By comparing available plans, you can see which prescriptions are covered, understand your out-of-pocket costs, and avoid unnecessary penalties or surprises. With the right guidance, choosing a Part D plan becomes a simple step toward managing prescription expenses with confidence and long-term peace of mind.
MEDICARE DISCLAIMER: It’s possible that we do not offer every plan in your area. We represent a number of Medicare Advantage organizations throughout the country which offer products in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all your options.