Medicare Part D: prescription coverage basics

Original Medicare doesn't cover most prescriptions you fill at a pharmacy. You get that coverage one of two ways.

Two ways to get drug coverage

• A stand-alone Part D plan, added to Original Medicare (with or without Medigap).
• A Medicare Advantage plan that includes drug coverage, which most do.

Check your drugs, not just the premium

Each plan has its own list of covered drugs (a formulary) and its own preferred pharmacies. The cheapest premium can cost more overall if your medicines aren't covered well. Enter your exact drugs and doses in the Medicare Plan Finder or give the list to an agent.

The 2026 cap

Your out-of-pocket costs for covered drugs are capped at $2,100 in 2026. After that, you pay nothing more for covered drugs for the rest of the year.

Avoiding the late penalty

If you go 63 days or more in a row without Part D or other creditable drug coverage after you first become eligible, a penalty is added to your premium for as long as you have Part D. Coverage from an employer or the VA often counts as creditable; ask for the yearly notice that says so.

Help with costs

Extra Help is a federal program that lowers drug premiums and copays for people with limited income and resources. You can apply through Social Security. 2026 limits and how to apply.