The Medicare Part D Spending Cap

In 2026, the Medicare Part D spending cap has been increased to $2,100 from the original spending cap of $2,000 born out of the 2025 Inflation Reduction Act. 

How It Works:

1. Annual Out-of-Pocket Cap:

Once your total out-of-pocket spending on Part D drugs reaches $2,100, you won’t have to pay anything more for covered prescriptions for the rest of the year. 

This replaces the current system, which has a catastrophic phase where patients still pay a percentage of drug costs. 

2. Monthly Payment Plan (New Option):  

Medicare will offer an option to spread out drug costs over the year rather than paying large sums at once.

This can help enrollees manage expenses more predictably. 

3. Who Benefits the Most?  

Beneficiaries with high prescription drug costs—especially those taking expensive specialty medications. 

Anyone who previously spent more than $2,100 annually on prescriptions. 

4. How to Prepare for 2026:   

Review your current Part D or Medicare Advantage plan to see how it covers your medications. 

Look into enrollment options for the new monthly payment plan if you prefer spreading costs over time. 

Stay updated with your plan provider on any changes in premiums, formularies, and copays. 

5. Does using GoodRx count towards the spending cap?   

No. In order to reach your spending cap, you must only use your Medicare prescription drug plan.