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Prescription Drug Plans, Part D
The piece Original Medicare leaves out entirely, and the one place your specific medication list decides everything.
Original Medicare does not cover prescriptions. Part D is how that gets solved, either as a standalone plan alongside Original Medicare, or built into a Medicare Advantage plan. It is sold by private carriers, so the plan you want depends less on the brochure and more on which of your drugs sit on which tier.
What changed, and why it matters
Part D used to have no ceiling. A year with an expensive medication could run indefinitely. That is no longer true.
Your spending is capped at $2,100
Once your out-of-pocket costs on covered drugs reach $2,100 in a calendar year, you pay nothing more for covered prescriptions for the rest of that year.
You can spread the cost across the year
Rather than absorbing a large charge at the pharmacy counter in January, you can choose to pay your out-of-pocket share in capped monthly amounts across the plan year.
The four things you pay
| Cost | How it works in 2026 |
|---|---|
| Monthly premium | Set by each plan and varies by ZIP code. The national base beneficiary premium, which is the figure used to calculate penalties and income surcharges rather than what you actually pay, is $38.99. |
| Annual deductible | No plan may charge more than $615. Many charge less, and some waive it on lower drug tiers. |
| Copays and coinsurance | What you pay per prescription after the deductible, determined by the tier your drug falls on in that plan's formulary. |
| Income surcharge | Higher incomes pay an extra amount on top of the plan premium, based on the tax return from two years earlier. |
The cheapest premium is rarely the cheapest plan
A plan with a low premium that puts one of your medications on a high tier can cost hundreds more across a year than a plan with a higher premium that covers it well. The only way to know is to price your actual drug list against each plan.
How to compare plans properly
Every Part D plan publishes a formulary, which is its list of covered drugs sorted into tiers. Two plans can both cover the same medication and charge very different amounts for it.
Pharmacy networks matter too. Most plans have preferred pharmacies where your cost is lower, and using a pharmacy outside that group can quietly raise what you pay all year.
This is the part of Medicare where a bad match costs real money and a good match is invisible. It is worth doing carefully once a year, because formularies change every January.
Bring these to the call
- Every medication you take, with the dose
- The pharmacy you actually use
- Whether you are on Original Medicare or an Advantage plan
- Any drug coverage you have now, including from an employer
How it fits with the rest of your coverage
You add a standalone plan
Parts A and B cover no prescriptions, so a separate Part D plan is how you get drug coverage.
You still add a standalone plan
Medigap covers cost sharing on Parts A and B. It never includes drugs. A Part D plan sits alongside it.
Usually already built in
Most Advantage plans include drug coverage. When yours does, you generally cannot also enroll in a separate Part D plan.
The penalty that never goes away
If you go without Part D or other creditable drug coverage after you are first eligible, a late enrollment penalty is added to your premium. It is calculated per month you went without, and it stays on your premium for as long as you have Part D.
People skip Part D most often because they take no medications yet. That is exactly the situation the penalty is built to discourage, since a cheap plan now is usually less expensive than the permanent surcharge later.
If money is tight
Extra Help is a federal program that lowers Part D premiums, deductibles, and copays for people with limited income and resources. Many who qualify never apply for it, often because nobody told them it exists. It is worth asking about before you settle on a plan.
The enrollment windows that govern Part D are the same ones covering the rest of Medicare, and they are laid out on our Enrollment Periods page.
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Medicare TPMO Compliance Statement
Complete Family Protection and its affiliates are not connected with or endorsed by any government entity or the federal Medicare program. Complete Family Protection represents Medicare Advantage HMO, PPO, and PFFS organizations and stand alone prescription drug plans that have a Medicare contract. Enrollment depends on the plan's contract renewal. While we have a database of every Medicare plan nationwide and can help you to search among all plans, we have contracts with many but not all plans. As a result, we do not offer every plan available in your area. Currently we represent 50 organizations which offer 15,778 products nationwide. We search and recommend all plans, even those we don't directly offer. You can contact a licensed Complete Family Protection agent to find out the number of products available in your specific area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.