{"id":9011,"date":"2026-01-14T21:25:20","date_gmt":"2026-01-14T21:25:20","guid":{"rendered":"https:\/\/healthmedicinet.com\/review\/hmn-medicare-part-d-plans-2026-vs-2025-what-changed-in-2026\/"},"modified":"2026-01-14T21:25:20","modified_gmt":"2026-01-14T21:25:20","slug":"hmn-medicare-part-d-plans-2026-vs-2025-what-changed-in-2026","status":"publish","type":"post","link":"https:\/\/healthmedicinet.com\/review\/hmn-medicare-part-d-plans-2026-vs-2025-what-changed-in-2026\/","title":{"rendered":"HMN: Medicare Part D plans 2026 vs. 2025: What changed? in 2026"},"content":{"rendered":"<p>\n<br \/>Do you know:  Medicare Part D plans 2026 vs. 2025: What changed? in 2026<\/p>\n<div id=\"main-content\">\n<div id=\"post-intro\">\n<div id=\"takeaways\">\n<h2>Key takeaways<\/h2>\n<ul>\n<li>\n<p><span style=\"font-weight: 400;\">The initial coverage limit increased from $2,000 to $2,100. Once a Part D beneficiary spends $2,100 on covered drugs, they pay no further cost-sharing.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">The national base premium and standard deductible increased.<\/span><\/p>\n<\/li>\n<li>\n<p><span style=\"font-weight: 400;\">The Medicare Extra Help program\u2019s resource limits and copayments for drugs increased.<\/span><\/p>\n<\/li>\n<\/ul>\n<\/div>\n<\/div>\n<p><span style=\"font-weight: 400;\">Those who are already enrolled in Original Medicare (Part A and Part B) may choose to enroll in prescription drug coverage through Medicare Part D, while Medicare Advantage Plans (Part C) typically offer prescription drug benefits to people who choose to enroll in their plan instead of Original Medicare with a standalone Part D plan. Like other health insurance plans, <\/span><span style=\"font-weight: 400;\">changes to the Medicare program occur from year to year<\/span><span style=\"font-weight: 400;\">. If you have Medicare in 2026, it\u2019s important to understand the drug coverage changes that went into effect for this year.<\/span><\/p>\n<h2 id=\"changes-to-medicare-part-d-plans-in-2026\"><span style=\"font-weight: 400;\">Changes to Medicare Part D plans in 2026<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">Aside from formulary changes, which can occur at any point throughout the year, you can expect to see several changes to your drug coverage plans in 2026.<\/span><\/p>\n<table class=\" singlecare-table\" role=\"table\">\n<thead>\n<tr>\n<th class=\"title\" role=\"columnheader\" scope=\"col\"><span class=\"title\">Medicare Part D plans 2026 vs. 2025<\/span><\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr>\n<td><b>Plan availability<\/b><\/td>\n<td><span style=\"font-weight: 400;\">The average Medicare beneficiary has access to 40\u201344 Medicare plans with Part D coverage, a 22% decrease.<\/span><\/td>\n<td><span style=\"font-weight: 400;\">The average Medicare beneficiary had access to 48 Medicare plans with Part D drug coverage.<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Monthly premiums<\/b><\/td>\n<td><span style=\"font-weight: 400;\">The national base premium for stand-alone Part D plans is $38.99.<\/span><\/td>\n<td><span style=\"font-weight: 400;\">The national base premium for stand-alone Part D plans was $36.78.<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Cost-sharing structure<\/b><\/td>\n<td><span style=\"font-weight: 400;\">The standard deductible is $615, the initial coverage limit and out-of-pocket threshold is $2,100.<\/span><\/td>\n<td><span style=\"font-weight: 400;\">The standard deductible was $590, and the out-of-pocket threshold was $2,000.<\/span><\/td>\n<\/tr>\n<tr>\n<td><b>Medicare Extra Help\u00a0<\/b><\/td>\n<td><span style=\"font-weight: 400;\">Resource limits are $18,090 for single people and $36,100 for married people.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Income limits are annual incomes below $23,475 for individuals and $31,725 for married couples.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A generic drug costs a maximum of $5.10, and a brand-name drug costs a maximum of $12.65.<\/span><\/p>\n<\/td>\n<td><span style=\"font-weight: 400;\">Resource limits are $17,600 for single people and $35,130 for married people.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Income limits are annual incomes below $22,836 for individuals and $30,900 for married couples.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">A generic drug costs a maximum of $4.90, and a brand-name drug costs a maximum of $12.15.<\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<h3 id=\"1-plan-availability\"><span style=\"font-weight: 400;\">1. Plan availability<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">In 2026, the average Medicare consumer will have access to approximately 8\u201312 Medicare Part D stand-alone plans (PDPs) and 32 Medicare Advantage drug plans (MA-PDs), according to <\/span><a href=\"https:\/\/www.kff.org\/medicare\/a-current-snapshot-of-the-medicare-part-d-prescription-drug-benefit\/?utm_source=chatgpt.com\"><span style=\"font-weight: 400;\">KFF<\/span><\/a><span style=\"font-weight: 400;\">.<\/span><\/p>\n<h3 id=\"2-monthly-premiums\"><span style=\"font-weight: 400;\">2. Monthly premiums<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">In 2026, there will be higher premiums on average for stand-alone Medicare Part D drug coverage.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The national base premium is $38.99 for 2026, according to the <\/span><a href=\"https:\/\/www.medicare.gov\/Pubs\/pdf\/11579-medicare-costs.pdf\"><span style=\"font-weight: 400;\">Centers for Medicare and Medicaid Services<\/span><\/a><span style=\"font-weight: 400;\">. This is an increase from $36.78 in 2025.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The average monthly premium for Medicare Advantage plans in 2026 will be $14 per month, compared to $17 in 2025.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Part D premiums vary by plan.<\/span><\/p>\n<h3 id=\"3-cost-sharing-structure\"><span style=\"font-weight: 400;\">3. Cost-sharing structure\u00a0<\/span><\/h3>\n<p><a href=\"https:\/\/www.healthcare.gov\/glossary\/cost-sharing\/\"><span style=\"font-weight: 400;\">Cost-sharing<\/span><\/a><span style=\"font-weight: 400;\"> is the portion of Medicare costs that you\u2019re required to pay out of your own pocket. This includes deductibles, coinsurance, and copayments. Several changes were made to the cost-sharing structure for 2024.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">The standard deductible increased by $25 in 2026, from $590 to $615.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Initial coverage limits increased by $100, from $2,000 to $2,100. This means that you\u2019ll pay your plan\u2019s copay or coinsurance rate until you and your plan have spent $2,100 on covered drugs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">After spending $2,100, you\u2019ll enter the catastrophic coverage stage and will no longer have any cost-sharing for your covered medications.<\/span><\/p>\n<p><b> <\/b><b>Important Medicare donut hole update<\/b><\/p>\n<p><span style=\"font-weight: 400;\">The Medicare Extra Help program is a low-income subsidy that helps eligible consumers pay for certain Medicare Part D costs. The <\/span><a href=\"https:\/\/www.medicare.gov\/basics\/costs\/help\/drug-costs\"><span style=\"font-weight: 400;\">income and resource limits<\/span><\/a><span style=\"font-weight: 400;\"> for determining Medicare Extra eligibility are the same as they were in 2025:\u00a0<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Income limits:<\/b><span style=\"font-weight: 400;\"> $23,475 for individuals and $31,725 for married couples<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><b>Resource limits:<\/b><span style=\"font-weight: 400;\"> $17,600 for individuals and $35,130 for married couples<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">For those enrolled in Medicare Extra Help, the <\/span><a href=\"https:\/\/www.cms.gov\/Medicare\/Prescription-Drug-Coverage\/LimitedIncomeandResources\/downloads\/11199.pdf\"><span style=\"font-weight: 400;\">maximum copayment<\/span><\/a><span style=\"font-weight: 400;\"> for generic drugs increased from $4.90 in 2025 to $5.10 in 2026. The maximum copayment below the out-of-pocket threshold for brand-name drugs increased from $12.10 to $12.65.\u00a0<\/span><\/p>\n<p><b> <\/b><b>Who qualifies for Medicare Extra Help?<\/b><\/p>\n<h2 id=\"how-to-find-the-best-medicare-part-d-drug-plan\"><span style=\"font-weight: 400;\">How to find the best Medicare Part D drug plan<\/span><\/h2>\n<p><span style=\"font-weight: 400;\">\u201cAlthough all Medicare drug plans meet a standard level of coverage, the medications, costs, and pharmacies you can use will vary,\u201d says <\/span><a href=\"https:\/\/www.linkedin.com\/in\/ashley-woodcox-6395a459\/\"><span style=\"font-weight: 400;\">Ashley Woodcox<\/span><\/a><span style=\"font-weight: 400;\">, executive director of <\/span><a href=\"https:\/\/www.brookdale.com\/en\/communities\/brookdale-carmel.html\"><span style=\"font-weight: 400;\">Brookdale Senior Living<\/span><\/a><span style=\"font-weight: 400;\">. \u201cIt\u2019s important to compare plan options and choose one that works best for your specific needs.\u201d<\/span><\/p>\n<h3 id=\"1-choose-between-a-stand-alone-part-d-plan-or-medicare-advantage-prescription-drug-coverage\"><span style=\"font-weight: 400;\">1. Choose between a stand-alone Part D plan or Medicare Advantage prescription drug coverage.\u00a0<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Stand-alone prescription drug plans (PDPs) are available to those already enrolled in Original Medicare (Part A or B). As an alternative, people with Medicare also have the option to enroll in a Medicare Advantage plan (Part C) with Part D drug coverage included. Medicare Advantage plans provide Medicare coverage through private companies instead of the federal government.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">In 2026, there will be more Medicare Advantage plans with Part D coverage than stand-alone plans; however, Medicare Advantage plans often have more network restrictions than Original Medicare.<\/span><\/p>\n<p><b> <\/b><b>Medicare Part D vs. Medicare Advantage<\/b><\/p>\n<h3 id=\"2-compare-several-plans-and-providers\"><span style=\"font-weight: 400;\">2. Compare several plans and providers.<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Every plan is different and will vary in terms of cost, coverage, and network providers. Examples of popular providers include Kaiser, Humana, United Healthcare, and BlueCross BlueShield. To compare plans, visit <\/span><a href=\"https:\/\/www.medicare.gov\/plan-compare\/#\/?lang=en&amp;year=2022\"><span style=\"font-weight: 400;\">medicare.gov<\/span><\/a><span style=\"font-weight: 400;\"> to use the Plan Finder tool or call 1-800-MEDICARE (1-00-633-4227). TTY users can call 1-877-486-2048.\u00a0<\/span><\/p>\n<h3 id=\"3-compare-the-plans-formularies-and-find-one-with-your-medication-on-a-lower-drug-tier\"><span style=\"font-weight: 400;\">3. Compare the plans\u2019 formularies and find one with your medication on a lower drug tier.<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">While your medication may be covered by several plans, it\u2019s important to know which tier your medication is on. For example, your medicine may be on one plan\u2019s lowest tier, so you\u2019ll pay the lowest amount, while that same drug may be on the highest tier for another plan, so you\u2019ll pay the highest amount. You\u2019ll also want to note formulary restrictions, such as preferred pharmacy networks and <\/span><span style=\"font-weight: 400;\">prior authorization<\/span><span style=\"font-weight: 400;\">, and then choose a plan with as few restrictions as possible.<\/span><\/p>\n<p><b> <\/b><b>What is a Medicare formulary?<\/b><\/p>\n<h3 id=\"4-compare-plans-annually-to-ensure-you-re-enrolled-in-the-best-drug-plan-for-your-prescription-needs\"><span style=\"font-weight: 400;\">4. Compare plans annually to ensure you\u2019re enrolled in the best drug plan for your prescription needs.<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">Drug formularies can change their covered drugs throughout the year. Part D enrollees have the option to change their plan every year during the annual Part D <\/span><span style=\"font-weight: 400;\">Open Enrollment Period<\/span><span style=\"font-weight: 400;\">, which occurs from Oct. 15 to Dec. 7.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400;\">If you don\u2019t wish to change plans during the Medicare Open Enrollment Period, your current Medicare coverage will automatically continue into the next year unless your plan is discontinued. If your plan is discontinued, you\u2019ll be automatically facilitated into a benchmark Part D plan unless you choose a new one.\u00a0<\/span><\/p>\n<h3 id=\"5-if-you-don-t-want-part-d-keep-records-of-creditable-drug-coverage\"><span style=\"font-weight: 400;\">5. If you don\u2019t want Part D, keep records of creditable drug coverage.<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">While Medicare Part D coverage isn\u2019t required and may not seem necessary to some, there may be a <\/span><span style=\"font-weight: 400;\">late enrollment penalty<\/span><span style=\"font-weight: 400;\"> if you decide not to elect coverage. This penalty applies to those who aren\u2019t enrolled in Part D or other creditable drug coverage for a continuous period of 63 days or more after their Initial Enrollment Period ends. For this reason, many Medicare enrollees choose to enroll in Medicare Part D prescription drug coverage as soon as they become eligible to avoid the potential for future penalties. If you qualify for Extra Help, it\u2019ll eliminate this penalty.<\/span><\/p>\n<h3 id=\"6-take-advantage-of-additional-savings-programs\"><span style=\"font-weight: 400;\">6. Take advantage of additional savings programs.<\/span><\/h3>\n<p><span style=\"font-weight: 400;\">It\u2019s important to note that although Medicare Part D helps you save money on prescription drugs, it\u2019s not free. The specific out-of-pocket costs vary based on the plan chosen. Each plan has its own yearly deductible, monthly premium, coinsurance, and\/or copayment. However, there are additional savings options to help further reduce the costs associated with your plan. Some examples of these savings options include:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><a href=\"https:\/\/www.ssa.gov\/benefits\/medicare\/prescriptionhelp.html\"><span style=\"font-weight: 400;\">Medicare Extra Help<\/span><\/a><span style=\"font-weight: 400;\">: Low-income Medicare beneficiaries with limited resources can get assistance through Extra Help. This program helps cover costs associated with Medicare drug plans, such as yearly deductibles, monthly premiums, and coinsurance.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\"><\/span><span style=\"font-weight: 400;\">: Compare your Medicare copays to  discounts before filling your prescriptions. This could help you save up to 80% on your medications at over 35,000 nationwide pharmacies. <\/span><span style=\"font-weight: 400;\">Get your free prescription discount card here.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400;\">Note: If you have a <\/span><span style=\"font-weight: 400;\">Medigap policy<\/span><span style=\"font-weight: 400;\"> (Medicare supplement plan), it will not help subsidize Part D costs. It only applies to Part A and B costs.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Lea este art\u00edculo en espa\u00f1ol aqu\u00ed.<\/span><\/p>\n<p><svg style=\"display:none\">\n  <g id=\"facebook\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M19.51 9.32003H21.39V6.14003C20.4798 6.04538 19.5652 5.99865 18.65 6.00003C15.93 6.00003 14.07 7.66003 14.07 10.7V13.32H11V16.88H14.07V26H17.75V16.88H20.81L21.27 13.32H17.75V11.05C17.75 10 18.03 9.32003 19.51 9.32003Z\"\/>\n  <\/g>\n  <g id=\"twitter\">\n    <rect width=\"32\" height=\"32\" rx=\"4\" fill=\"var(--social-bg)\"\/>\n    <path fill=\"var(--social-ico)\" d=\"M26 9.9506C25.2483 10.2767 24.4534 10.4923 23.64 10.5906C24.4982 10.0779 25.1413 9.27138 25.45 8.3206C24.6436 8.80066 23.7608 9.1389 22.84 9.3206C22.2245 8.65317 21.405 8.2089 20.5098 8.05745C19.6147 7.90601 18.6945 8.05596 17.8938 8.48379C17.093 8.91162 16.4569 9.59313 16.0852 10.4214C15.7135 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<\/g>\n<\/svg>\t\t\t\t\t\t\t\t<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Do you know: Medicare Part D plans 2026 vs. 2025: What changed? in 2026 Key takeaways The initial coverage limit increased from $2,000 to $2,100. Once a Part D beneficiary spends $2,100 on covered drugs, they pay no further cost-sharing. The national base premium and standard deductible increased. The Medicare Extra Help program\u2019s resource limits [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-9011","post","type-post","status-publish","format-standard","hentry","category-health-news"],"blocksy_meta":[],"_links":{"self":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/9011","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/comments?post=9011"}],"version-history":[{"count":0,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/posts\/9011\/revisions"}],"wp:attachment":[{"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/media?parent=9011"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/categories?post=9011"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/healthmedicinet.com\/review\/wp-json\/wp\/v2\/tags?post=9011"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}