Whether you are enrolled in Traditional Medicare (which the government administers directly) or a Medicare Advantage plan (which corporate health insurers administer,) Medicare covers the prescription drugs you get from the pharmacy under Medicare Part D. The vast majority of people with Medicare, 54.8 million in 2025, are enrolled in a Part D drug plan out of a total of 68.8 million. Here’s what you need to know about Medicare Part D coverage and costs in 2026.
Part D insurers change their costs and coverage each year, so it’s important to take a good look at what your Part D plan covers and costs. Assume that your costs will go up a lot each year, if you didn’t check which Part D plan was likely to save you the most money based on your drug needs, during the Medicare open enrollment period (October 15-December 7). Kaiser Family Foundation offers key facts about Part D plans in 2026.
As a general rule, close to three in four people enrolled in Traditional Medicare and a Part D plan will pay higher costs the following year, if they do not look at their options and switch plans. This year, 13.9 million people with Medicare paid no Part D premium because they were enrolled in the Low-Income Subsidy (LIS) Program.
In 2026, there are 360 prescription drug plans available nationally, according to the Kaiser Family Foundation. If you are in Traditional Medicare, you will be able to choose from among 8 to 12 Part D plans in your state. Monthly premiums range from $0 to more than $100. Individuals with annual incomes above $106,000 a year (couples $212,000) pay an additional $13.70 to $85.80 per month in 2025.
Premiums: Premiums are typically higher for Part D plans offering enhanced benefits, lower cost-sharing and/or low or no deductibles.
Standard deductible: The standard and highest possible deductible—the amount you must pay before your coverage begins—is $615.
If you have Traditional Medicare: You typically will be able to choose among 8-12 Part D drug plans.
If you are in a Medicare Advantage plan: You typically will have a choice of around 35 Part D drug plans.
Cost-sharing: For non-preferred brand-name drugs, coinsurance could be as high as 40-50 percent and as low as $0 for preferred generics, depending upon the Part D plan you choose. You also are likely to pay 15-25 percent coinsurance for preferred brand drugs.
Typically you’ll pay between 0 and $10 for generics. You’ll pay between $25 and $50 copay for preferred brands, and more for non-preferred drugs.
Maximum out-of-pocket: The most you will pay out of pocket for drugs you purchase through Part D is $2,100 in 2026. You will have no additional costs for your covered drugs after you spend $2,100.
Costs after the deductible: After you have paid your deductible, you generally will pay 25 percent of the cost of both brand-name and generic drugs until your out-of-pocket drug costs total $2,100. All Part D drug plans must cover all Medicare-negotiated drugs at all dosage forms and levels.
If you qualify for a low-income subsidy (LIS) or Extra Help: You will have lower out-of-pocket costs, depending upon the Part D plan you choose and the drugs you use. In 2025, you pay $4.90 for each generic drug that is covered and $12.15 for each brand-name covered drug. Around 13 million people with Medicare qualify for extra help with their prescription drug costs. There are 198 Part D drug plans for which you will not pay a premium. You can also choose a “non-benchmark” plan and pay a portion of the monthly premium.
You should get Extra Help automatically if you have full Medicaid benefits or are receiving SSI benefits. If not, you can apply for Extra Help through the Social Security Administration. To qualify, generally, an individual’s countable income needs to be below $23,475 and your assets need to be below $17,600 in 2025.
If you need insulin: The Inflation Reduction Act limits your monthly copayment to no more than $35. However, that limit applies only to insulin in a plan’s formulary, not all insulin products.
If you need a vaccine: Vaccine costs are covered in full for vaccines that are on the Part D formulary.
Here’s more from Just Care:
- Prescription drug middlemen, PBMs, will always drive up drug costs
- Six tips for keeping your drug costs down if you have Medicare
- Enrolling in Medicare? Here’s a checklist
- Five ways to ensure the people you love are safe and healthy
- Roundup: Planning for life’s curve balls
