Medicare Part D Out-of-Pocket Maximum 2026

The 2026 cap that protects you from runaway prescription costs.

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Quick answer

In 2026, the Medicare Part D out-of-pocket maximum is $2,100. Once your spending on covered drugs reaches that cap, you pay $0 for covered medications for the rest of the year. The cap applies to every Part D and Medicare Advantage drug plan, per CMS.

The 2026 Part D out-of-pocket maximum is one of the most important protections in Medicare drug coverage. Here is exactly how the $2,100 cap works.

What counts toward the $2,100 cap?

Your deductible, copays, and coinsurance on covered Part D drugs all count toward the $2,100 out-of-pocket maximum in 2026. Once your true out-of-pocket spending reaches that amount, you enter the catastrophic phase and pay nothing for covered medications for the rest of the calendar year. Monthly premiums do not count toward the cap. The cap resets each January 1. This protection, created by the Inflation Reduction Act, replaced the old donut hole and limits what any beneficiary pays for covered drugs in a year.

How does the cap help people with high drug costs?

Before 2025, there was no annual ceiling, and people on expensive specialty drugs could pay many thousands of dollars. With the 2026 cap at $2,100, your worst-case spending on covered drugs is predictable and limited. If you face high costs early in the year, the Medicare Prescription Payment Plan lets you spread that $2,100 into monthly installments instead of paying it at once. The cap applies automatically — you do not need to enroll separately. Questions about how it affects your medications? Call 1-800-MEDIGAP.

More on Part D & Prescription Drugs

← Part D & Prescription Drugs (overview)pillar guide Medicare Part D Medicare Prescription Payment Plan Medicare Prescription Drug Plans 2026 Medicare Part D Formulary Part D Late Enrollment Penalty Medicare Donut Hole 2026 Creditable Drug Coverage

Frequently asked questions

What is the Part D out-of-pocket maximum for 2026?+

The 2026 Part D out-of-pocket maximum is $2,100. After your spending on covered drugs reaches that amount, you pay $0 for covered medications for the rest of the year. The cap applies to all Part D and Medicare Advantage drug plans.

Does my premium count toward the $2,100 cap?+

No. Only your deductible, copays, and coinsurance on covered drugs count toward the $2,100 out-of-pocket maximum. Monthly plan premiums do not count. Once your eligible out-of-pocket spending hits the cap, covered drugs cost you nothing for the rest of the year.

Does the cap reset each year?+

Yes. The out-of-pocket maximum resets every January 1. Spending toward the cap does not carry over, so each calendar year you start again at zero and work toward the new annual limit, which is $2,100 in 2026.

Can I spread the $2,100 over the year?+

Yes. The Medicare Prescription Payment Plan lets you pay your out-of-pocket drug costs in monthly installments rather than all at once at the pharmacy. It does not lower the $2,100 total but smooths large bills. Call 1-800-MEDIGAP to learn how to enroll.

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