Medicare 101
Understanding Medicare Part D
Medicare Part D covers prescription drugs through private plans. You can get it standalone (with Original Medicare or Medigap) or inside a Medicare Advantage plan. Each plan has a formulary (its covered-drug list) with tiers that set your cost. For 2026, there's a $2,100 annual out-of-pocket cap (CMS, 2026).
Choosing the right plan
Match your exact medications to each plan's formulary and tiers — not just the premium. The right plan can save hundreds a year. We run your drug list for you.
Questions, answered
What is the Part D donut hole in 2026?
The coverage-gap 'donut hole' is effectively gone, replaced by a $2,100 annual out-of-pocket cap (CMS, 2026). After you hit it, covered drugs cost $0 the rest of the year.
Do all Part D plans have the same $2,100 cap?
Yes — the $2,100 out-of-pocket cap is a federal requirement under the Inflation Reduction Act and applies to every Part D plan, whether standalone or built into a Medicare Advantage plan. What varies by plan is your deductible, copays, and formulary tiers on the way to that cap — which is why the cheapest premium isn't always the lowest total cost.
Can I spread my Part D out-of-pocket costs evenly across the year?
Yes. Medicare's Prescription Payment Plan lets you pay your share of drug costs in monthly installments spread across the plan year instead of all at once at the pharmacy. It doesn't lower your total cost, but it can make high-cost months easier to manage — ask us or your plan to opt in.
Does the $2,100 cap include my monthly Part D premium?
No. The cap applies to your out-of-pocket cost-sharing for covered drugs — deductible, copays, and coinsurance. Your monthly Part D plan premium is separate and continues even after you hit the cap.
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