Original Medicare
Part D (Drugs)
Standalone drug plans with formularies, tiers, and spend phases. 2026 annual OOP cap of $2,100; $35/month insulin cap continues.
The quick version
If you only read one thing, read this
- 1
Helps pay outpatient prescription drugs via private plan formularies.
- 2
2026: premium varies by plan + ~$615 deductible + copays until $2,100 OOP cap, then $0 for covered drugs. Insulin capped at $35/month.
- 3
No health underwriting; late enrollment without creditable coverage triggers a permanent premium penalty.
The details
The stuff that matters, one piece at a time
Benefits
Helps pay outpatient prescription drugs via private plan formularies.
What it costs
Show me the money
- Part B Premium (2026)
- $202.90/mo USDStandard; IRMAA surcharges above $109k/$218k
- Part A Deductible (2026)
- $1,736 USDPer benefit period
- Part B Deductible (2026)
- $283/yr USDThen 20% coinsurance
- Out-of-Pocket Cap
- NoneNo annual limit on Part A/B cost sharing
- Average Plan Premium
- $30–$50/moNational average; varies by plan/region
- Standard Deductible (2026)
- ~$615 USDSome plans waive or reduce
- Annual OOP Cap (2026)
- $2,100 USDThen $0 for covered drugs
- Insulin Cap
- $35/moContinues under Inflation Reduction Act
The honest take
What's good, and where it falls short
The good stuff
- Annual OOP cap ($2,100 in 2026) then $0 for covered drugs
- Insulin capped at $35/month
- Wide range of plan options and formularies
The catch
- Formulary restrictions (prior auth, step therapy)
- Premiums, deductibles, and formularies change annually
- Late enrollment penalty if delaying without creditable coverage
Head to head
Original Medicare vs. Medicare Advantage
Original Medicare gives maximum flexibility but no spending cap. Advantage bundles everything with a MOOP.
Buyer beware
The mistakes that cost folks the most
Delaying Part D without creditable coverage triggers ~1% permanent premium penalty per month late
Not reviewing your plan's formulary each year. Drugs can change tiers or be dropped each Jan 1
Not understanding the new benefit structure. The IRA removed the coverage gap ("donut hole") and added a $2,100 OOP cap for 2026
Common questions
What folks ask us most
Keep learning
Watch these next
The Insurance Hawk
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See the plans and the prices. Or talk it through with a licensed agent who works for you, not the insurance company.