Medicare Part D for 2026 introduces several changes designed to make drug costs more predictable and affordable, with new protections and negotiation effects taking shape nationwide. Here’s the core picture you’ll want to know.
- Out-of-pocket cap: For 2026, Part D enrollees will have a $2,100 out-of-pocket maximum for covered drugs. Once this threshold is reached in a plan year, the plan covers 100% of remaining covered drug costs for the year. The Part D deductible in 2026 rises to $615, up from $590 in 2025. After meeting the deductible, cost-sharing (copays/coinsurance) continues until beneficiaries reach the $2,100 out-of-pocket limit.
- Drug price negotiations: The first group of drugs eligible for government-negotiated price reductions under Part D will begin in 2026. Ten initial brand-name drugs without generic/biosimilar options will be subject to price negotiations, with substantial potential savings passed to beneficiaries. CMS announces the exact list of drugs and the magnitude of discounts and can change annually as more drugs are added.
- You can continue to choose from many standalone Part D plans or from Medicare Advantage plans that include drug coverage. Each plan sets its own formulary (approved drug list), deductibles, and cost-sharing, so shopping remains essential.
- Because Part D offerings and premiums vary by state and county, local market changes in 2026 may result in more favorable or less favorable options, depending on location, manufacturer contracts, and plan design. Checking your local plan landscape is advised.
- The new out-of-pocket cap of $2,100 provides a more predictable annual maximum for drug costs, which helps with budgeting and reduces the risk of runaway expenses due to high-priced medications.
- The start of price negotiations for certain high-cost drugs is expected to lower out-of-pocket spending on those drugs for enrollees once the negotiated prices take effect in 2026.
- Higher deductible, but lower long-run costs: While the deductible increases to $615, the overall cost picture may improve for many beneficiaries as the cap and negotiated prices reduce total yearly spending. It’s essential to compute total costs (premiums plus anticipated cost-sharing) across plans.
- Plan shopping remains crucial: Because plans differ in premium levels, deductible amounts, covered drugs, and formulary tiers, beneficiaries should compare plans during the annual enrollment period to determine which plan minimizes total costs given current medications.
- Review your current medications: List the drugs you take regularly, including their names, doses, and whether they have generic alternatives. This helps you judge formulary coverage and expected cost-sharing under different plans.
- Consider state-specific changes: Some states may see larger premium declines or shifts in available plans in 2026. Review your local market’s 2026 PDP landscape when planning enrollment.
At 65 Plus Health Plans, I can help you compare Part D plans for 2026 and estimate your total annual costs, including the impact of the new out-of-pocket cap and potential negotiated-price savings.