Key takeaways
In 2026, Medicare Part D costs include a maximum deductible of $615, an average monthly premium of $38.99, and varying copays and coinsurance up to $2,100 out of pocket.
In 2025, the Medicare Part D donut hole (or coverage gap) was eliminated.
Late enrollment in Medicare Part D results in a penalty calculated as 1% of the national base beneficiary premium for each month without coverage. This penalty is added to the monthly premium and is permanent unless you qualify for Medicaid, Extra Help, or a Medicare Savings Program.
Medicare Part D drug insurance plans help millions of Americans afford prescription drugs. But understanding out-of-pocket costs with Medicare can be overwhelming, considering there are monthly premiums, annual deductibles, copays, and coinsurance to consider. We’ll break down the costs associated with Medicare Part D so you can better estimate and even lower your out-of-pocket costs.
Compare Medicare Part D costs over time |
|||
|---|---|---|---|
| 2026 | 2025 | 2024 | |
| Deductible | $0–$615 | $0–$590 | $0–$545 |
| Premium | $38.99 per month national base premium | $36.78 per month national base premium | $34.70 per month national base premium |
| Copay/coinsurance | Varies by drug, plan, and coverage stage. | ||
| Initial coverage limit | $2,100 | $2,000 | $5,030 |
| Coverage gap (“donut hole”) | No longer applies. | No longer applies. | Beneficiary pays 25% of drug costs until they have spent $8,000 out of pocket for the calendar year. |
| Late enrollment penalty | Beneficiaries who do not enroll in a Part D plan when they first become eligible, who do not have “creditable coverage,” and who are not low-income pay 1% of the national base beneficiary premium multiplied by the number of months they’ve been without Part D. The monthly premium is rounded to the nearest $0.10 and added to your monthly Part D premium. This penalty is permanently eliminated for beneficiaries who qualify for Medicaid, Extra Help, or a Medicare Savings Program. Learn more on medicare.gov. | ||
Source: Medicare changes
Deductible
How much do you have to pay out of pocket before Medicare Part D coverage starts?
The cost of your Medicare Part D deductible varies depending on your drug plan. In 2026, the highest deductible price was $615, an increase from $590 in 2025. However, not all plans have a deductible.
Premiums
How much does Medicare Part D cost per month?
Since not everyone needs prescription drugs, Medicare prescription drug coverage is optional.
For those with a Part D plan, you may have to pay a monthly premium.
The Part D national base beneficiary premium (or the amount Part D plans start at) can change yearly. In 2026, the national base beneficiary premium is $38.99 per month for each Part D beneficiary.
There is also a Part D income-related monthly adjustment amount, or IRMAA, meaning that people with higher incomes may have to pay more according to their most recent tax return.
2026 Part D income-related monthly adjustment amount |
||
|---|---|---|
| Individual tax returns | Joint tax returns | Income-related monthly adjustment amount |
| $109,000 or less | $218,000 or less | Beneficiaries just pay their health plan’s premium each month |
| $109,001-$137,000 | $218,001-$274,000 | Pay an additional $14.50 per month |
| $137,001-$171,000 | $274,001-$342,000 | Pay an additional $37.50 per month |
| $171,001-$205,000 | $342,001-$410,000 | Pay an additional $60.40 per month |
| $205,001-$499,999 | $440,001-$749,999 | Pay an additional $83.30 per month |
| $500,000 or more | $750,000 or more | Pay an additional $91 per month |
| Married but filing separately | Income-related monthly adjustment amount | |
| $109,000 or less | Beneficiaries just pay their health plan’s premium each month | |
| $109,001-$390,999 | Pay an additional $83.30 per month | |
| $391,000 or more | Pay an additional $91 per month | |
Source: Centers for Medicare & Medicaid Services
Copays and coinsurance
How much does Medicare Part D cost per drug?
A copayment, or copay, is a set amount (for instance, $10) that you pay for a prescription each time you get it filled, while your Part D plan pays for the rest.
Coinsurance means that you pay a percentage of the cost (for instance, 25%) of the drug each time you fill it, while the plan pays the rest.
Cost-sharing is set by each plan, and some plans have different copays or coinsurance for generic drugs and brand-name drugs. Each drug is assigned a tier on your plan’s drug formulary. The lower the tier, the cheaper the copay or coinsurance will be. Brand-name drugs are often included in more expensive, higher tiers.
Once you spend $2,100 on out-of-pocket costs, you’ll enter the catastrophic coverage stage, and you’ll pay no further cost-sharing.
Other Medicare Part D costs
Late enrollment penalties
A less obvious plan cost that some people get stuck with is the late enrollment penalty, which affects anyone who doesn’t opt for a Medicare Part D plan within their seven-month initial Open Enrollment Period but then decides to enroll in Part D later. The penalty, which is a percentage of the Part D national base beneficiary premium, goes up for each month you go without prescription drug coverage, and you will have to pay it for the life of your Part D drug plan, except for the following reasons:
- You have “creditable” drug coverage, which is a plan that is at least as good as what Medicare offers. Most employer plans and ACA plans will qualify as creditable.
- You qualify for Extra Help.
- You have proof that you received bad information about whether your drug coverage before getting Part D was “creditable.”
Drugs that are not covered by Part D
Another factor that could contribute to prescription drug costs is if you need a medication that isn’t included in your plan’s drug list or formulary. Insurance companies compile a list of drugs related to your condition that they will cover. If you need a drug that isn’t on the list, you could end up paying full price for it. Also, if you are using a drug for off-label use, you could be responsible for the full cost of your drug—even if it’s on your formulary.
RELATED: What drugs are covered by Medicare Part D?
Is Medicare Part D ever free?
To help ease the burden on those who need help affording their prescriptions, Medicare Part D includes a low-income subsidy known as Extra Help. For individuals who qualify, Extra Help can reduce plan premiums, deductibles, and copays. It will also eliminate the late enrollment penalty and give people with Medicare a monthly Special Enrollment Period. Under the program, generic drugs should cost no more than $5.10, and brand-name drugs should cost no more than $12.65 in 2026. To see if you qualify for Extra Help, visit ssa.gov.
If you have Original Medicare (Parts A and B), you may be familiar with Medigaps, which are Medicare supplement insurance plans that help lower the costs of Original Medicare. However, Medigaps do not include prescription drug benefits, so they will not help with the costs of Part D.
You can always use SingleCare to save on your prescriptions, even if you have Medicare. Your price with SingleCare may be more affordable than Medicare if you are in the coverage gap or if your medication isn’t covered by Medicare. For more info on how to use our savings with Medicare, read this article.
Lea este artículo en español aquí.
- Medicare Part D in 2025, KFF (2024)
- An overview of the Medicare Part D prescription drug benefit, KFF (2023)
- A primer on Medicare: Key facts about the Medicare program and the people it covers, KFF (2015)
- Welcome to Medicare, Centers for Medicare & Medicaid Services
- Monthly premium for drug plans, Centers for Medicare & Medicaid Services
- 2026 Medicare Parts A & B premiums and deductibles, Centers for Medicare & Medicaid Services (2025)
- Catastrophic coverage, Centers for Medicare & Medicaid Services
- Inflation Reduction Act and Medicare, Centers for Medicare & Medicaid Services (2025)
- Help with drug costs, Centers for Medicare & Medicaid Services
- Apply for Medicare Part D Extra Help program, Social Security Administration