Updated August 3, 2026. Quick answer: in 2026 your out-of-pocket costs for covered Part D drugs are capped at $2,100. Once you hit it you pay nothing more for covered drugs for the rest of the calendar year. This is the most consequential change to Medicare drug coverage in years, and it is frequently quoted with last year’s number.
The 2026 figures
| Stage | What you pay in 2026 |
|---|---|
| Deductible | Up to $615 — some plans have none |
| Initial coverage | 25% coinsurance on covered drugs |
| After $2,100 out of pocket | $0 for covered Part D drugs for the rest of the year |
Medicare states it directly: “Your yearly out-of-pocket drug costs for drugs covered by your plan are capped at $2,100 in 2026.” And on the deductible: “No Medicare drug plan may have a deductible more than $615 in 2026, and some plans have no deductible.”
Check the year on any figure you read
The cap is indexed and it moves. A great deal of material published in 2025 quotes $2,000, which was that year’s figure. For 2026 it is $2,100. Any page telling you the cap without telling you the year is a page to distrust — including this one, which is why the year is on every number.
What the cap does not do
- It applies to covered drugs only. If your plan does not cover a drug, what you spend on it does not count toward the cap and is not capped by it. The formulary is still the thing that matters most.
- It does not cap premiums. Your monthly premium is separate, and so is any IRMAA surcharge on it.
- It resets every January.
The payment-spreading option, and its honest limit
Medicare offers the Prescription Payment Plan: “This payment option works with your current drug coverage to help you manage your out-of-pocket costs for drugs covered by your plan by spreading them across the calendar year (January-December). This payment option might help you manage your expenses, but it doesn’t save you money or lower your drug costs.”
The second half of that sentence is Medicare’s own, and it is the important half. It spreads the cost; it does not reduce it. It helps someone who would otherwise face a large bill in January and cannot absorb it. It does nothing for someone whose problem is the total. Participation is voluntary and free to join.
How to choose a plan once the cap is a given.
Scope note: the figures above are the 2026 rules as published by Medicare. We have not restated the history of what this structure replaced, because we could not re-verify that from a primary source in the same pass.
General information drawn from Medicare, CMS and state insurance-department publications, not insurance advice. Medicare rules, plan availability and dollar figures change every year, and state rules differ. Every figure here is year-labelled and every source is named so you can check it against your own situation. We do not sell insurance and receive nothing if you buy a plan.