{"id":46,"date":"2015-07-20T15:50:56","date_gmt":"2015-07-20T15:50:56","guid":{"rendered":"https:\/\/medicarereport.org\/?page_id=46"},"modified":"2026-08-07T11:37:20","modified_gmt":"2026-08-07T15:37:20","slug":"part-d","status":"publish","type":"page","link":"https:\/\/medicarereport.org\/?page_id=46","title":{"rendered":"Medicare Part D – Prescription Drug Coverage"},"content":{"rendered":"

Medicare drug coverage helps pay for prescription drugs you need. It’s optional and offered to everyone with Medicare. Even if you don\u2019t take prescription drugs now, consider getting Medicare drug coverage. If you decide not to get it when you\u2019re first eligible, and you don\u2019t have other creditable prescription drug coverage (like drug coverage from an employer or union) or get Extra Help, you\u2019ll likely pay a\u00a0late enrollment penalty<\/a> if you join a plan later. Generally, you\u2019ll pay this penalty for as long as you have Medicare drug coverage. To get Medicare drug coverage, you must join a Medicare-approved plan that offers drug coverage. Each plan can vary in cost and specific drugs covered.<\/p>\n

Except for vaccines covered under Medicare Part B (Medical Insurance), Medicare drug plans must cover all commercially available vaccines (like the shingles vaccine) when medically necessary to prevent illness.<\/p>\n

There are 2 ways to get Medicare drug coverage:<\/strong>
\n1. Medicare drug plans. These plans add drug coverage to Original Medicare, some Medicare Cost Plans, some Private Fee\u2011for\u2011Service plans, and Medical Savings Account plans. You must have Medicare Part A (Hospital Insurance) and\/or Medicare Part B (Medical Insurance) to join a separate Medicare drug plan.<\/p>\n

2. Medicare Advantage Plan (Part C) or other Medicare Health Plan with drug coverage. You get all of your Part A, Part B, and drug coverage, through these plans. Remember, you must have Part A and Part B to join a Medicare Advantage Plan, and not all of these plans offer drug coverage.<\/p>\n

To join a Medicare drug plan, Medicare Advantage Plan, or other Medicare health plan with drug coverage, you must be a United States citizen or lawfully present in the United States.<\/p>\n

Deductibles vary between Medicare drug plans. No Medicare drug plan may have a deductible more than $615 in 2026). Some Medicare drug plans don’t have a deductible. In some plans that do have a deductible, drugs on some tiers are covered before the deductible.<\/p>\n

Medicare Part D Income-Related Monthly Adjustment Amounts<\/strong><\/p>\n

Since 2011, a beneficiary\u2019s Part D monthly premium has been based on his or her income. Approximately 8% of people with Medicare Part D pay these income-related monthly adjustment amounts. These individuals will pay the income-related monthly adjustment amount in addition to their Part D premium. Part D premiums vary by plan and, regardless of how a beneficiary pays their Part D premium, the Part D income-related monthly adjustment amounts are deducted from Social Security benefit checks or paid directly to Medicare. Roughly two-thirds of beneficiaries pay premiums directly to the plan while the remainder have their premiums deducted from their Social Security benefit checks. The 2026 Part D income-related monthly adjustment amounts for high-income beneficiaries are shown in the following table:<\/p>\n\n\n\n\n\n\n\n\n\n\n\n
\n

Part D\u00a0 IRMAA\u00a0<\/strong><\/p>\n<\/th>\n<\/tr>\n<\/thead>\n

Beneficiaries who file individual tax returns with modified adjusted gross income:<\/strong><\/td>\nBeneficiaries who file joint tax returns with modified adjusted gross income:<\/strong><\/td>\n\n

Income-related monthly adjustment amount<\/strong><\/p>\n<\/td>\n<\/tr>\n

Less than or equal to $109,000<\/td>\nLess than or equal to $218,000<\/td>\n\n

$0.00<\/p>\n<\/td>\n<\/tr>\n

Greater than $109,000 and less than or equal to $137,000<\/td>\nGreater than $218,000 and less than or equal to $274,000<\/td>\n\n

$14.50<\/p>\n<\/td>\n<\/tr>\n

Greater than $137,000 and less than or equal to $171,000<\/td>\nGreater than $274,000 and less than or equal to $342,000<\/td>\n\n

$37.50<\/p>\n<\/td>\n<\/tr>\n

Greater than $171,000 and less than or equal to $205,000<\/td>\nGreater than $342,000 and less than or equal to $410,000<\/td>\n\n

$60.40<\/p>\n<\/td>\n<\/tr>\n

Greater than $205,000 and less than $500,000<\/td>\nGreater than $410,000 and less than $750,000<\/td>\n\n

$83.30<\/p>\n<\/td>\n<\/tr>\n

Greater than or equal to $500,000<\/td>\nGreater than or equal to $750,000<\/td>\n\n

$91.00<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Premiums for high-income beneficiaries who are married and lived with their spouse at any time during the taxable year, but file a separate return, are as follows:<\/p>\n\n\n\n\n\n\n\n\n
\n

Part D<\/strong><\/p>\n<\/th>\n<\/tr>\n<\/thead>\n

Beneficiaries who are married and lived with their spouses at any time during the year, but file separate tax returns from their spouses with modified adjusted gross income:<\/strong><\/td>\n\n

Income-related monthly adjustment amount<\/strong><\/p>\n<\/td>\n<\/tr>\n

Less than or equal to $109,000<\/td>\n\n

$0.00<\/p>\n<\/td>\n<\/tr>\n

Greater than $109,000 and less than $391,000<\/td>\n\n

$83.30<\/p>\n<\/td>\n<\/tr>\n

Greater than or equal to $391,000<\/td>\n\n

$91.00<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

If your income is above a certain limit, you’ll pay an income-related monthly adjustment amount in addition to your plan premium.\u00a0<\/strong><\/p>\n

The Medicare Part D donut hole has been eliminated in 2026, replaced by a $2,100 annual out-of-pocket cap for prescription drugs.<\/p>\n

Key Changes in 2026<\/strong>
\nAs of 2026, the traditional Medicare Part D coverage gap, commonly known as the “donut hole,” no longer exists. Instead, beneficiaries are protected by a hard out-of-pocket cap of $2,100 for the year. Once this limit is reached, Medicare Part D or Medicare Advantage prescription plans cover 100% of covered drug costs for the remainder of the year<\/p>\n

In order to determine whether or not to choose Part D and what Part D plan is right for you, it is important to understand:<\/p>\n

    \n
  1. if the prescriptions you take are covered;<\/li>\n
  2. how much they cost;<\/li>\n
  3. if the plan premiums are worth it for your situation; and<\/li>\n
  4. \u00a0if you want an upgraded plan that may not have a deductible or has better coverage than the Standard Medicare Part D plan.<\/li>\n<\/ol>\n
    \n

    Extra help\/Low-income subsidy (LIS).\u00a0 <\/strong>If you meet certain income and resource limits, you may qualify for a program called\u00a0Extra Help<\/span><\/a>\u00a0from Medicare to pay the prescription costs, premiums, deductibles, and coinsurance\u00a0of Medicare prescription drug coverage.<\/p>\n<\/div>\n

    Part D late enrollment penalty<\/strong><\/p>\n

    The late enrollment penalty is an amount added to your Medicare Part D monthly premium. You may owe a late enrollment penalty if, for any continuous period of 63 days or more after your Initial Enrollment Period is over, you go without one of these:<\/p>\n