Key takeaways
- The Part D out-of-pocket cap is $2,100 for 2026, up from $2,000 in 2025.
- Once you reach it, covered Part D drugs cost you nothing for the rest of the calendar year.
- Before the cap you pay 25% coinsurance on covered generics and brand-name drugs after any deductible.
- The cap applies to covered drugs on your plan's formulary, so a drug your plan does not cover does not count toward it.
The annual out-of-pocket ceiling for Medicare Part D is $2,100 for 2026, up from the $2,000 cap that took effect in 2025. The increase is the 2025 figure indexed for inflation rather than a policy change.
- 2026 out-of-pocket cap
- $2,100
- 2025 cap
- $2,000
- Coinsurance before the cap
- 25%
covered Part D drugs
the first year a hard cap applied
generic and brand-name, after any deductible
How the year now works
After any plan deductible, you pay 25% of the cost as coinsurance for covered generic and brand-name drugs. Once your out-of-pocket spending on covered Part D drugs reaches $2,100, catastrophic coverage begins automatically and you pay nothing for covered Part D drugs for the remainder of the calendar year.
Where the enrolment windows sit
Part D runs on the Medicare calendar, not the Marketplace one. If you are new to Medicare, the Initial Enrollment Period is the seven months around your 65th birthday.
Turning 65
The seven months of your Initial Enrollment Period
The window opens three months before the month you turn 65 and closes three months after it. Enrolling early is what avoids a gap.
Months
View the data as a table
| Category | Months |
|---|---|
| Before your birthday month | 3 |
| Your birthday month | 1 |
| After your birthday month | 3 |
Late enrolment in Part D can carry a penalty that stays with the premium, so confirm your own dates with Medicare rather than working from a figure remembered from a previous year.
Sources
Checked . Figures are published by the organisations below; confirm the current year before relying on any of them.
- 1How much does Medicare drug coverage cost?Medicare.gov
- 2Final CY 2026 Part D Redesign Program InstructionsCenters for Medicare & Medicaid Services
