Medicare Prescription Drug Plans - Adams Health Insurance Services

Getting Started

Medicare Part D

Medicare Part D also called Prescription Drug Plans are also offered by private insurance companies, and you can review and choose a plan that best suits your needs.

Part D

Medicare Part D - Prescription Drug Plans

Medicare Part D is voluntary, meaning you can choose to have a Prescription Drug Plan. But be careful, if you do not enroll into a Prescription Drug Plan or a plan that includes Prescription Drug coverage, you will be penalized by Medicare. Prescription Drug Plans are often coupled with a Medicare Supplement plan to give more of a complete cover for their members. Remember that Medicare Advantage plans include prescription drug coverage. If you do enroll in Part D when you are first eligible, you will be able to access retail prescription drugs at a more affordable rate and enjoy protection against high costs in the event you need a very expensive medication.

Cost

Key Changes to Medicare Part D in 2026:

$2,100 Out-of-Pocket Cap: This is the maximum you’ll pay out of pocket for covered Part D prescription drugs in a year. Once you reach this amount, your plan pays 100% of covered drug costs for the rest of the plan year.
“Donut Hole” or Coverage Gap: The traditional Medicare Part D donut hole has already been eliminated (starting in 2025). In 2026, there still is no coverage gap — you move from initial coverage straight to catastrophic coverage once you hit your out-of-pocket cap.
Monthly Payment Flexibility: Beneficiaries can continue the Part D Prescription Payment Plan, allowing them to spread out expected out-of-pocket prescription costs over monthly payments throughout the year (if they opt in).
Enhanced Coverage for Vaccines: Part D will continue to offer vaccines at no cost to the patient, including shingles and other preventive vaccines, ensuring access to essential immunizations.
Lower Costs for Insulin: The cap on insulin prices, initiated in 2023, will continue in 2026, limiting out-of-pocket costs to $35 per month for insulin products, regardless of coverage phase.
Negotiated Drug Prices: For at least ten high-cost medications take effect on January 1, 2026 which should reduce costs for many beneficiaries.

Consideration

Key Considerations

Plan Selection: Beneficiaries should review Medicare Part D plans to ensure they are choosing one that covers their specific medications and suits their budget.
Formulary Check: Review the formulary (list of covered drugs) for each plan to ensure your prescriptions are covered.
Extra Help: Low-income individuals may qualify for additional assistance with premiums and drug costs through the “Extra Help” program.

These updates to Medicare Part D for 2026 are part of an effort to make prescription drugs more affordable and accessible for all beneficiaries.

How does it work

How do Prescription Drug Plans work?

When you purchase prescriptions at the pharmacy, your Prescription Drug Plan allows for affordable co-pay for your medication. Medications in a Prescription Drug Plan are grouped into tiers that have specific pricing. From your generic drugs to your specialty drugs, your Prescription Drug Plan can offer you coverage. Each time you must purchase a prescription drug in the corresponding tier, you pay the tier co-pay.

Enrollment

How do I enroll in Prescription Drug Plan?

You are eligible for Prescription Drug Plans when you first become eligible for Medicare (at age 65). You can consult with one of our Licensed Insurance Agents, who will be happy to explain your plan options, or you can enroll in a Prescription Drug Plan directly through Medicare. Call 1-800-MEDICARE or visit Medicare’s website for enrollment information. If you don’t enroll in Medicare Part D when you are first eligible for Medicare, you can elect a plan later. Each year, during Medicare’s Annual Election Period from October 15 to December 7, you can add, drop, or change your plan selections.