Medicare Part D 2026: Deductible, Out-of-Pocket Cap, Premium and Payment Plan
The 2026 Medicare Part D deductible, out-of-pocket cap and base premium from CMS, how the Prescription Payment Plan spreads the cost, and a calculator for your own drugs.
In 2026 a Medicare Part D plan can charge a deductible of at most $615 ($590 in 2025). After it you pay 25% of the cost of covered drugs until your out-of-pocket spending reaches $2,100 ($2,000 in 2025); then you pay nothing for covered drugs for the rest of the year (CMS, CY 2026 Rate Announcement (7 April 2025), Table V-2 Part D benefit parameters; CMS, Final CY 2026 Part D Redesign Program Instructions). Your premium is set by your plan; the national base beneficiary premium, $38.99 a month, is the yardstick for the late-enrollment penalty (CMS, Annual Release of Part D National Average Bid Amount (28 July 2025)). Above the income thresholds a Part D IRMAA of $14.50 to $91.00 a month is added.
Official Every figure on this page is published by the responsible agency; none is a projection.
| Figure | 2025 | 2026 | 2027 |
|---|---|---|---|
| Deductible (the most a plan may charge) | $590 | $615 | $700 |
| Coinsurance after the deductible | — | 25% | — |
| Out-of-pocket cap: after it you pay $0 | $2,000 | $2,100 | $2,400 |
| National base beneficiary premium (monthly; the penalty yardstick) | — | $38.99 | $41.33 |
| Insulin, per one-month supply of each covered product | — | at most $35 | — |
These are the limits of the standard benefit (CMS, Final CY 2026 Part D Redesign Program Instructions): a plan may charge a lower deductible or none, and your plan’s own costs are in its plan documents. The $2,100 cap counts your deductible and your share of covered drugs, plus payments made for you such as Extra Help; it does not count premiums (Medicare.gov, Medicare costs (what you pay in 2026)). In a plan with the standard design you reach it once your covered drugs have cost $6,555 in total ($615 + ($2,100 − $615) ÷ 25%). Insulin: Medicare.gov, Insulin coverage. Base premium: CMS, Annual Release of Part D National Average Bid Amount (28 July 2025) (2026), CMS, Medicare Part D 2027 National Average Monthly Bid Amount Information (28 July 2026) (2027).
The Medicare Prescription Payment Plan
Every plan must offer it: instead of paying the pharmacy, you get a monthly bill from your plan that spreads your out-of-pocket costs over the rest of the calendar year. It costs nothing to join and does not lower what you pay in total (Medicare.gov, What's the Medicare Prescription Payment Plan?). The most the plan can bill in your first month is $2,100 minus what you have already paid this year, divided by the months left; later months spread whatever is still unbilled plus new costs over the months left. Joining in January with a drug that reaches the cap at once, that is at most $175.00 a month. Plans renew your participation automatically each year unless you opt out (42 CFR §423.137 (Medicare Prescription Payment Plan)).
Part D IRMAA: the 2026 income surcharge
| Single | Joint | Surcharge |
|---|---|---|
| over $109,000 to $137,000 | over $218,000 to $274,000 | +$14.50 |
| over $137,000 to $171,000 | over $274,000 to $342,000 | +$37.50 |
| over $171,000 to $205,000 | over $342,000 to $410,000 | +$60.40 |
| over $205,000, under $500,000 | over $410,000, under $750,000 | +$83.30 |
| $500,000 or more | $750,000 or more | +$91.00 |
Low income instead? Extra Help 2026 limits: copays of at most $5.10 / $12.65 → The 2027 figures: Medicare Part D 2027 →
Your 2026 Part D out-of-pocket cost
The full price your plan pays plus your share, before any discount to you. Uses the standard benefit ($615 deductible, then 25%, capped at $2,100); your plan may charge less. Premiums are not included.
Your Part D surcharge is set by your income two years earlier. QuantCalc runs your whole retirement — Social Security, withdrawals, taxes, Medicare surcharges — year by year.
Run the free tax-aware simulation →Common questions
What is the Medicare Part D premium for 2026?
Each plan sets its own premium. The national base beneficiary premium is $38.99 a month (CMS, Annual Release of Part D National Average Bid Amount (28 July 2025)); it sizes the late-enrollment penalty rather than any bill. With 2024 income over $109,000 (single) or $218,000 (joint) a Part D IRMAA of $14.50 to $91.00 a month is added (CMS, 2026 Medicare Parts A & B Premiums and Deductibles (14 November 2025)).
What is the Part D deductible for 2026?
At most $615, up from $590 in 2025; plans may charge less or none (CMS, CY 2026 Rate Announcement (7 April 2025), Table V-2 Part D benefit parameters).
What is the Medicare Part D out-of-pocket maximum for 2026?
$2,100, up from $2,000 in 2025. Once your deductible and your share of covered drugs reach it, you pay $0 for covered drugs for the rest of 2026 (CMS, Final CY 2026 Part D Redesign Program Instructions; Medicare.gov, Medicare costs (what you pay in 2026)).
How does the Medicare Prescription Payment Plan work in 2026?
You pay your plan in monthly bills instead of paying at the pharmacy. The bills spread your out-of-pocket costs over the rest of the year, at most ($2,100 minus what you have paid) divided by the months left in your first month; it costs nothing and does not lower your total (42 CFR §423.137 (Medicare Prescription Payment Plan); Medicare.gov, What's the Medicare Prescription Payment Plan?).
How much is insulin with Medicare Part D in 2026?
No more than $35 for a one-month supply of each covered insulin product (Medicare.gov, Insulin coverage).
What changes in Part D for 2027?
The deductible rises to $700, the out-of-pocket cap to $2,400 and the base beneficiary premium to $41.33 (CMS, CY 2027 Rate Announcement (6 April 2026), Part D benefit parameters table; CMS, Medicare Part D 2027 National Average Monthly Bid Amount Information (28 July 2026)). See Medicare Part D 2027.
Sources
- CMS, CY 2026 Rate Announcement (7 April 2025), Table V-2 Part D benefit parameters
- CMS, Final CY 2026 Part D Redesign Program Instructions
- CMS, CY 2027 Rate Announcement (6 April 2026), Part D benefit parameters table
- CMS, Annual Release of Part D National Average Bid Amount (28 July 2025)
- CMS, Medicare Part D 2027 National Average Monthly Bid Amount Information (28 July 2026)
- 42 CFR §423.137 (Medicare Prescription Payment Plan)
- Medicare.gov, What's the Medicare Prescription Payment Plan?
- Medicare.gov, Insulin coverage
- Medicare.gov, Medicare costs (what you pay in 2026)
- CMS, 2026 Medicare Parts A & B Premiums and Deductibles (14 November 2025)
Every figure on this page is read at build time from one dataset and was checked against the text of the documents above on October 11, 2026. Every figure with its source: JSON. QuantCalc is calculation software, not tax, legal or benefits advice.
Related
Medicare Part D 2027 → Extra Help 2026 limits → Every 2026 Medicare cost → 2026 IRMAA brackets → Late-enrollment penalty calculator →