Every Senior Benefit

Medicare Part D (drug coverage)

In short: Medicare drug coverage comes from private plans approved by Medicare: either a stand-alone drug plan added to Original Medicare, or a Medicare Advantage plan that includes drugs. In 2026 the most you pay out of pocket for covered drugs is $2,100 (In 2027: $2,400). If you go without drug coverage when you first can get it, you may pay a penalty for life.

How it works

  • Each plan has a list of covered drugs (a formulary), its own premium, and its own pharmacy network.
  • Deductible: plans can charge up to $615 in 2026 (In 2027: $700) before coverage starts. Many charge less.
  • After the deductible: you pay a copay or coinsurance for each prescription.
  • Yearly cap: once your out-of-pocket costs for covered drugs reach $2,100, you pay nothing more for covered drugs for the rest of the year.
  • Insulin: covered insulin costs no more than $35 for a month’s supply.
  • Recommended vaccines, such as shingles, are free.
  • Spreading costs: the Medicare Prescription Payment Plan lets you pay your drug costs in monthly amounts over the year instead of all at once at the pharmacy. Ask your plan.

Choosing a plan

Plans change their premiums and drug lists every year. Compare plans each fall using your own drug list:

  • Online: medicare.gov/plan-compare
  • By phone: 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048), 24 hours a day. Interpreters are available.
  • Free counseling: your SHIP at shiphelp.org or 877-839-2675.

When you can join or switch:

  • When you first get Medicare (your Initial Enrollment Period).
  • Every year from October 15 to December 7, for coverage starting January 1.
  • At other times in special cases, such as moving or losing other coverage. People with Extra Help or Medicaid can change plans more often.

The late penalty

If you go 63 days or more in a row without Part D or other drug coverage that is at least as good (called creditable coverage, for example from an employer or the VA), you may pay a penalty when you join. It is 1% of the national base premium ($38.99 in 2026) for each full month without coverage, added to your premium for as long as you have Part D. People who get Extra Help do not pay this penalty.

Help paying for drugs

Extra Help can lower your premium and deductible to little or nothing and cap your copays at $5.10 for generic drugs and $12.65 for brand-name drugs in 2026.

Check what you may qualify for

Sources

Page last reviewed: 1791763200