2026 TOOL · EN · BEFORE OPEN ENROLLMENT
Medicare Part D Cost Estimator 2026
The $38.99 decision before October 15: see your true annual drug cost under the 2026 benefit — $615 deductible, 25% coinsurance, $2,100 out-of-pocket cap — then check whether your current plan is still the cheapest.
Checking Medicare open enrollment dates…
The 2026 numbers that decide your bill
| Parameter | 2026 (final, CMS) | 2027 (final, CMS) |
|---|---|---|
| National base beneficiary premium | $38.99/month | $41.33/month |
| Standard maximum deductible | $615/year | $700/year |
| Annual out-of-pocket cap (covered drugs) | $2,100 | $2,400 |
| Initial-coverage coinsurance | 25% | 25% |
| Catastrophic phase (your cost) | $0 after cap | $0 after cap |
| Premium Stabilization Demonstration | Active — caps 2026 increases | Ends Dec 31, 2026 |
The donut hole is gone — three phases only: deductible → initial coverage → catastrophic. The deductible counts toward the $2,100 cap; premiums do not.
Why October matters: the stabilization demo ends December 31, 2026. About 45% of stand-alone Part D enrollees face $11–$20/month premium increases for 2027 (WSJ via techtimes.com).
Step 1 — Estimate your 2026 annual drug cost
Your 2026 estimate
$0Annual premiums
$0Drug cost-sharing
$0Total annual cost
NoHit the $2,100 cap?
| Benefit phase | What you pay | Your estimate |
|---|---|---|
| Deductible | 100% up to your deductible | $0 |
| Initial coverage (25% coinsurance) | 25% of drug cost after deductible | $0 |
| Catastrophic ($0 phase) | $0 for covered drugs, rest of year | $0 |
2027 preview (illustrative)
| 2026 estimate | 2027 preview | Change | |
|---|---|---|---|
| Annual premiums | $0 | $0 | $0 |
| Drug cost-sharing | $0 | $0 | $0 |
| Total | $0 | $0 | $0 |
Step 2 — Is your current plan still the cheapest? (5 questions)
1.Did your Annual Notice of Change show a premium increase of more than $10/month for 2027?
2.Did any medications change tiers or get dropped from the formulary?
3.Did you start any new brand-name or specialty drugs this year?
4.Do you fill at a pharmacy outside your plan's preferred network?
5.Did your annual drug spending change significantly?
Insulin, vaccines, and the payment plan
- $35/month insulin cap: insulin on formulary costs ≤$35/month in every phase — no deductible.
- $0 adult vaccines under Part D.
- Medicare Prescription Payment Plan: spread out-of-pocket drug costs across the year in monthly bills. Auto-renews into 2027 if you stay in the same plan.
- 2027: 15 more drugs (incl. Ozempic, Wegovy, Rybelsus) get Medicare-negotiated prices Jan 1, 2027.
Frequently asked questions
- What does Medicare Part D cost in 2026?
$38.99/month base premium, $615 maximum deductible, $2,100 out-of-pocket cap (CMS). - What changes in 2027?
$41.33 premium, $700 deductible, $2,400 cap. Stabilization demo ends Dec 31, 2026. - When can I change plans?
Open enrollment: October 15 – December 7, 2026, for coverage starting Jan 1, 2027. - Is there still a donut hole?
No — three phases: deductible, initial coverage (25% coinsurance), catastrophic ($0 after cap). - Do high earners pay more?
Yes — IRMAA surcharge adds $14.50–$91.00/month.
Sources
CMS 2026/2027 parameters via: AMAC; getsmartquotes.com (CMS Rate Announcement); govtschemes.org; techtimes.com (WSJ 45% figure); medicareagentshub.com; ihealthagents.com (CMS $34.50 avg premium).
Important: Cost estimates using the standard benefit formula — not insurance, plan, or medical advice. Verify with your Annual Notice of Change and the official Medicare plan finder before choosing.