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Looking toward your 2026 Medicare Part D coverage
The Centers for Medicare and Medicaid Services (CMS) has released the proposed standard benefits for 2026 Medicare Part D prescription drug plan coverage. You can click here for a table comparing changes in Medicare Part D standard benefit coverage from 2006 through 2026.
Some key points for 2026 Medicare Part D coverage:
• The standard initial deductible will increase from $590 in 2025 to $615 in 2026.
• The 2026 Initial Coverage phase will continue until the $2,100 RxMOOP or TrOOP threshold is met. The $2,100 RxMOOP should be reached when a person purchases Medicare Part D formulary drugs with a retail value of approximately $6,555. Although, if you are enrolled in an Enhanced Alternative (EA) Medicare Part D plan (PDP or MAPD), you will get TrOOP credit for the greater of either what you spend on Part D formulary drugs under your EA Medicare plan or what you would have spent if you were covered by a Defined Standard Part D plan. (You can click here for an example of how your EA Part D plan can save you additional money).
• Any plan members exceeding the $2,100 RxMOOP will enter the Catastrophic Coverage phase and pay no additional cost-sharing for formulary drugs through the remainder of the plan year.
• HHS will negotiate prices for 10 Medicare Part D drugs (single-source drugs with the highest Medicare Part D spending).
The Centers for Medicare and Medicaid Services (CMS) has released the proposed standard benefits for 2026 Medicare Part D prescription drug plan coverage. You can click here for a table comparing changes in Medicare Part D standard benefit coverage from 2006 through 2026.
Some key points for 2026 Medicare Part D coverage:
• The standard initial deductible will increase from $590 in 2025 to $615 in 2026.
• The 2026 Initial Coverage phase will continue until the $2,100 RxMOOP or TrOOP threshold is met. The $2,100 RxMOOP should be reached when a person purchases Medicare Part D formulary drugs with a retail value of approximately $6,555. Although, if you are enrolled in an Enhanced Alternative (EA) Medicare Part D plan (PDP or MAPD), you will get TrOOP credit for the greater of either what you spend on Part D formulary drugs under your EA Medicare plan or what you would have spent if you were covered by a Defined Standard Part D plan. (You can click here for an example of how your EA Part D plan can save you additional money).
• Any plan members exceeding the $2,100 RxMOOP will enter the Catastrophic Coverage phase and pay no additional cost-sharing for formulary drugs through the remainder of the plan year.
• HHS will negotiate prices for 10 Medicare Part D drugs (single-source drugs with the highest Medicare Part D spending).
