Medicare Part D 2026 Coverage Levels

 

Part D Benefit Cost Periods	Costs and Who Pays	Beneficiary Pays (TrOOP)	Plan Pays	Total Amount Spent on Plan-Covered Drugs
Initial Deductible	Beneficiary pays 100%	Up to $615	$0	$615 (Amount spent on deductible, before ICP begins)
Initial Coverage Period (ICP)	Costs of covered drugs are shared: 25% by beneficiary, 75% by plan	Up to $1,485 (max a person would pay for covered drugs with no deductible)	$4,455	$2,100 True Out-of-Pocket (TROOP) maximum (Includes what the beneficiary pays plus the 10% manufacturer discount on brand-name drugs during the Initial Coverage Phase.)
Catastrophic Benefit Period	When an enrollee’s total out-of-pocket spending reaches $2,100, they hit the catastrophic benefits period. After this point, the beneficiary does not have to pay anything for their prescription drugs for the rest of the year.	$0	100%	Beneficiary will remain in the Catastrophic Benefit Period through Dec. 31, 2026. Part D benefit will reset on Jan. 1, 2027, starting again with a deductible.

Source: Centers for Medicare & Medicaid Services (CMS) https://www.cms.gov/newsroom/fact-sheets/medicare-advantage-and-medicare-prescription-drug-programs-remain-stable-cms-implements-improvements

Additional Part D Information

Deductible is annual.

• You pay the plan retail cost for your medications until the deductible is met.
• If your plan has no deductible, initial coverage starts with your first fill.
• Some plans offer at least one drug tier with No Part D Deductible.

Catastrophic max out-of-pocket:

• $2,100 (includes deductible)
• If a drug is not covered, its cost does not count toward any Part D phase totals.

Medicare Prescription Payment Plan:

• Optional. You pay the plan, not the pharmacy.
• Spreads drug costs over the year (does not lower the cost).