Medicare · Prescription Drug Coverage (Part D)
Drug coverage that finally has a ceiling.
Part D helps pay for your prescriptions — as a stand-alone plan beside Original Medicare or bundled into a Medicare Advantage plan. And since 2025, it comes with something it never had before: a hard yearly cap on what you pay.
The 2025 redesign
The “donut hole” is gone.
For years, Part D had a dreaded coverage gap. The Inflation Reduction Act eliminated it: since January 2025 there are just three simple phases — and a ceiling.
Deductible
You pay your drug costs until the plan’s deductible is met (plans set this up to a federal maximum).
Initial coverage
You pay your share — typically 25% or your plan’s copays — while the plan pays the rest.
The cap
Once your out-of-pocket drug spending reaches the annual cap (about $2,100 in 2026), you pay $0 for covered drugs the rest of the year.
Two more 2026 facts worth knowing: covered insulin is capped at $35 a month, and the Medicare Prescription Payment Plan lets you spread your yearly drug costs into even monthly payments instead of paying big sums at the pharmacy counter.
How plans price drugs
Formularies and tiers, decoded
Every plan keeps a formulary — its covered-drug list — organized into tiers that set your cost share. Same medication, very different price from plan to plan.
Tier 1
Generic drugs
Lowest copays
Tier 2
Preferred brand-name
Medium copays
Tier 3
Non-preferred brand-name
Higher copays
Specialty
High-cost medications
Highest cost share
Choosing well
Five questions that pick the right plan
- 1Are your specific medications on the plan’s formulary?
- 2Is your pharmacy in the plan’s preferred network?
- 3Do you take generics — and how does the plan price them?
- 4Would bundling drug coverage into a Medicare Advantage plan fit better?
- 5What are the deductible and copays across the year — not just the premium?
Fika makes it easy
Bring your medication list. We’ll do the rest.
The right Part D plan is the one that covers your prescriptions at your pharmacy for the least across the whole year. We run your exact list against every plan in your area and show you the real annual cost — free, no pressure, no spam.
FAQs
Part D questions, answered
Anyone enrolled in Medicare — Part A and/or Part B — can get drug coverage: 65 or older, under 65 with Medicare through disability, or with End-Stage Renal Disease. You add it either as a stand-alone plan next to Original Medicare or bundled inside a Medicare Advantage plan.
Explore Medicare