Part D Prescription Drug Plans

You can sign up for Part D Prescription Drug Plans, which helps cover prescription drug costs, along with other components of Medicare starting three months before your 65th birthday, or if you are under 65 and eligible for Medicare.

It's important to do this on time because there may be a permanent premium surcharge for enrolling after your initial enrollment period if you don't have equivalent drug coverage from another source, such as a retiree plan.

If you are already enrolled in a Part D "standalone" plan or a Medicare Advantage plan that incorporates drug coverage, you can switch plans during the open-enrollment period, which runs from Oct. 15 to Dec. 7 every year.

Making Part D work

Your out-of-pocket spending on covered drugs will be capped at $2,100 in 2026.. This means that once you reach $2,100 in prescription expenses, you will not have additional out-of-pocket costs for the remainder of the year. This cap is aimed at helping individuals manage high prescription costs throughout the year. 

You will continue to pay consistent cost-sharing percentages in the initial phase. The deductible is also rising slightly to $615 for many plans, although this may vary depending on individual plan details. Part D drug benefits in 2026 are structured into three phases:

1. Annual deductible. If your plan has a deductible, you will pay 100% of your gross covered prescription drug costs until the annual deductible is met. 
2. Initial coverage. Once the annual deductible is met, you will pay 25% coinsurance for covered Part D drugs. This phase ends when you have reached the annual out-of pocket cap of $2,100 for 2026. 
3. Catastrophic. Once you meet the $2,100 out-of-pocket cap, you will pay no cost sharing for covered Part D drugs.

These updates aim to make Part D costs more predictable and manageable, especially for those with high-cost medications. The changes are part of the broader Inflation Reduction Act adjustments, which bring greater financial relief to Medicare enrollees in need of costly prescriptions.

Choosing a plan

It pays to review your Part D coverage every year, especially if you have started taking new drugs.

• Start at Medicare.gov, where find the basics about the benefit and Part D plans. There's a link to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area and includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs. It will even show you your monthly out-of-pocket drug cost for the year.

Call us to help you understand your options.

Getting financial help

Individuals 2025 annual incomes of less than $23,475 and financial resources of up to $17,600 or married couples with incomes of less than  $31,725 and financial resources of up to $35,130 might qualify for Extra Help from Medicare to pay their Part D premiums and out-of-pocket drug costs.

See Medicare's instructions on applying for the Extra Help program.

CA Prescription Drug Discount Program for Medicare Recipients

California law enables Medicare recipients to obtain their prescription drugs at a cost no higher than the Medi-Cal price for those drugs.

Here’s how it works:

1. You must have a Medicare card, and show it to the pharmacy staff.
2. Give your prescription to the pharmacy staff, ask for the Medi-Cal prescription price, and ask if that is the lowest price the pharmacy will accept for the drug.
3. If the Medi-Cal price is lower, you can pay that price, plus a small processing fee of $0.15, for the prescribed drug.
4. You must pay for the prescription in full at the pharmacy: if you have prescription drug coverage, your insurance company is not eligible to receive the Medi-Cal price.
5. Only Medi-Cal provider pharmacies are required by law to offer and accept the Medi-Cal price as payment for prescription medication for Medicare recipients. However, non-Medi-Cal pharmacies may also offer the Medi-Cal price if they choose.

Prescription Drug Discount Program for Medicare Recipients

Additionally, read about the ways to lower your drug costs on Medicare.gov.

This information was obtained from www.medicare.gov

By contacting the phone number on this website you will be directed to a licensed agent.