Are you ready for the changes coming to Medicare Part D plans?
Dear Toni: Currently, I am on a stand-alone Part D plan with a Medicare supplement because of my serious health issues. Last week, I received information about the 2026 changes to the Medicare Part D plan I am currently enrolled in, and the premium is increasing by $50 per month, from $44.80 to $94.80 beginning Jan. 1.
The Part D plan also informed me that two of my expensive prescriptions for my heart and rheumatoid arthritis will no longer be covered on this plan as of January.
Toni, please explain what I need to do to change to a Part D plan that will cover all of my prescriptions before Medicare’s open enrollment period ends Dec. 7. — Tammy, Cypress, Texas
Dear Tammy: The 2026 Part D plans became available to the public Oct. 1 at Medicare.gov, and there are serious changes, with Part D premiums increasing. Consult this site to find an affordable plan that covers your current prescriptions.
The good news is that Medicare negotiated directly with manufacturers for the price of certain expensive brand-name Part D drugs, and the price change will be effective Jan. 1 for Eliquis, Xarelto, Januvia, Jardiance, Farxiga, Entresto, Enbrel, Imbruvica, Stelara and NovoLog/Fiasp (insulin aspart).
For 2026, Part D will have three main stages: deductible, initial coverage and catastrophic coverage. Costs are as follows:
The initial deductible: $615.
There are six drug tiers of initial coverage: Drug tier 1, preferred generic drugs; drug tier 2, generic drugs, drug tier 3, preferred brand drugs; drug tier 4, nonpreferred drugs; drug tier 5, specialty drugs; and drug tier 6, select care drugs (which begins for the first time Jan. 1).
Initial coverage stage: During the initial coverage period with the six drug tiers, the Part D plan pays its share of the cost of your drugs, and you pay yours until the maximum out-of-pocket amount of $2,100 is met. Then you move to the catastrophic coverage stage.
Catastrophic coverage: A Medicare beneficiary pays $0 out of pocket after entering the catastrophic coverage stage. Medicare will pick up all prescription costs, whether brand name or generic, with a stand-alone Part D plan or Medicare Advantage with a Part D plan included.
Annual reset: On Jan. 1 of each year, the process starts all over again with a new Medicare prescription drug plan and new initial deductible and maximum initial coverage limit that leads to the catastrophic coverage stage.
The Medicare prescription payment plan is an option that began Jan. 1 to help manage out-of-pocket drug costs by spreading monthly prescription costs throughout the year from January to December. For more information about the payment plan, visit Medicare.gov.
Toni King is an author and columnist on Medicare and health insurance issues. If you have a Medicare question, email info@tonisays.com or call 832-519-8664.