2026 Standard Medicare Part D Prescription Drug Benefit

The 2026 Standard Medicare Part D Prescription Drug Benefit has just been released, and I wanted to share a quick breakdown to help you understand the upcoming changes.
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🗓️ Effective January 1, 2026

Drug plan stages: Your cost share is separated into 3 stages.
Stage 1 – Deductible
• $615 standard deductible
• Some plans may waive the deductible.

Stage 2 – Initial Coverage (Copay/Coinsurance Stage)
• You pay 25% of medication costs until you reach $2,100 TrOOP
• Your actual plan may offer better copays.

Stage 3 – Catastrophic Coverage (TrOOP Reached)
• After spending $2,100 out-of-pocket (TrOOP), you’ll pay $0 for plan-covered medications.
• What are covered medications? Medications on the plan formulary (drug list), or that you have an exception for.
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📬 What to Watch For
In late September or early October, you will receive your Annual Notice of Change (ANOC) from your Part D or Medicare Advantage plan.

This document outlines several things including:
• Plan continuation or termination
• Premium changes
• Covered medications
• Deductible/copayment adjustments
• Changes in preferred pharmacy networks
• Any tier changes (e.g., your medication could shift from Tier 3 to Tier 4)
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💡 Remember:
Plans can structure their benefits differently from the standard. Your plan may waive the deductible, raise or lower copays, or have a different formulary—so it’s always wise to review your medications against your plan each year.
If you’d like to go over your current coverage or explore your options for *2026, I will be here to help.
*2026 plan details will be available October 1.