Are there changes in Medicare Part D prescription drug coverage for 2026?

Yes. The Part D benefit changed fundamentally in 2025, and the dollar limits move again in 2026 and 2027.

The coverage gap is gone

The stage people called the donut hole was eliminated on January 1, 2025 by the Inflation Reduction Act. There is no longer a phase where your share of drug costs suddenly jumps, and there is no longer an unlimited amount you can spend in a year.

How Part D works now

1. Deductible stage. You pay the full negotiated price until you meet your plan’s deductible. The maximum any plan may charge is $615 in 2026 and $700 in 2027. Many plans charge less, and some charge nothing.
2. Initial coverage stage. You pay a copay or coinsurance for each prescription and the plan pays the rest.
3. Catastrophic stage. Once your out-of-pocket spending on covered drugs reaches the annual cap, you pay $0 for covered Part D drugs for the rest of the year. The cap is $2,100 in 2026 and $2,400 in 2027.

Other changes worth knowing

• Negotiated prices. The first prices negotiated by Medicare under the Inflation Reduction Act take effect in 2026 for a set of high-spend drugs.
• Monthly payment option. The Medicare Prescription Payment Plan lets you spread your out-of-pocket costs into monthly installments instead of paying a large amount at the pharmacy counter. You have to opt in.
• Insulin and vaccines. Covered insulin is capped at $35 for a month’s supply, and adult vaccines recommended by ACIP are $0.
• Premiums. The average stand-alone Part D premium is projected at $34.50 per month in 2026, down from $38.31 in 2025.
• Plan availability. Some insurers have withdrawn or consolidated stand-alone drug plans, so the plan you had may not exist in the same form next year. Read the annual notice of change your plan sends each fall.

What counts toward the cap

Only what you, or someone paying on your behalf, spend on covered drugs counts toward the annual cap. Your monthly premium does not count, and neither does anything you buy that your plan does not cover. The cap resets every January 1.

Talk to a licensed iHealthAgents advisor

We can walk you through what these amounts mean for your own coverage and compare every plan available where you live.

Book a time with a licensed advisor, or call Illinois 312-726-6565 or Texas 972-666-0578.

This article is for educational purposes only and is not a substitute for advice about your specific situation. Figures shown are the 2026 and 2027 amounts published by the Centers for Medicare & Medicaid Services.