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Medicare Part D changes

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  5. Introduction to Medicare
  7. How Medicare Part D is changing in 2026
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What's changing for Medicare Part D in 2026?


With 45 years of experience you can count on, we understand that Medicare coverage is personal and changes to your coverage can affect your life. That’s why UnitedHealthcare wants you to be aware of industry-wide changes to Medicare Part D prescription drug coverage in 2026. Even as regulations impact the entire Medicare industry again this year, you can count on UnitedHealthcare to provide reliable Medicare Advantage coverage and support every step of the way.

Maximum out-of-pocket drug cost

 

The out-of-pocket maximum for a Medicare Part D prescription drug plan is $2,100 in 2026.

Part D prescription drug deductible

 

The Part D prescription drug deductible is set by the federal government. In 2026 that amount is $615.

What to know about
Medicare Part D prescription drug deductibles in 2026

Video transcript

Your Medicare prescription drug costs may be changing in 2026. Here’s what you need to know. Due to industry-wide trends in Medicare drug coverage, deductibles are becoming more common in Medicare Part D plans.

 

What is a Medicare Part D prescription drug deductible? Let’s discuss. A deductible is the amount that you or others on your behalf pay toward your Medicare Part D prescription drugs before Medicare or other insurance starts to pay. The deductible only needs to be met once per plan year and may only apply to certain prescription drug tiers.

 

Let’s walk through an example with a Tier 3 drug. Let’s say your plan has a prescription drug deductible of $400 for drugs in Tiers 3, 4, and 5, and 20% coinsurance for Tier 3 drugs. Then, let’s say you need to fill your Tier 3 drug that costs $600.

 

Your first prescription fill of the year could look something like this: Because your drug cost is higher than the deductible, you’ll owe the full $400 deductible amount. At this point, there’s a $200 drug cost remaining.

 

Once you reach the deductible amount, you’ll enter the Initial Coverage stage. In this stage, you’ll begin to pay your plan’s cost-shares, including copays and coinsurance. Of the $200 remaining drug cost, you’ll pay 20% coinsurance, which is $40. Your plan will pay the remaining $160. This means you’ll owe $440 for your Tier 3 drug.

 

Now, let’s review what your second prescription drug fill of the year could look like. Because your deductible has already been met, you’re still in the Initial Coverage stage. So, with a $600 drug, your coinsurance payment will be $120 (20% of $600 is $120). The plan pays the remaining cost of $480.

 

You’ll remain in the Initial Coverage stage until you reach the plan’s out-of-pocket maximum. At this point, you’ll pay $0 for covered Part D drugs for the remainder of the year. If you have a deductible, this amount can be found in your Evidence of Coverage document. Keep in mind, deductible amounts can change each year. It’s important to review your Annual Notice of Changes, sent in September, to know what to expect in the next plan year.

 

You can count on UnitedHealthcare to provide you with reliable Medicare information and support every step of the way. For more information on Medicare Part D, visit uhc.com/medicare.

 

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    Here's what you need to know

     

    In 2026, the out-of-pocket limit for drug costs is $2,100.

    If you have Medicare Part D coverage, your out-of-pocket maximum for covered prescription drugs is $2,100 in 2026. Your premiums, copays, coinsurance or deductibles may be different compared to what you paid previously. Costs can change from year to year, so always review your new plan documents.

    Use our Drug Cost Estimator to see what your Part D covered prescription drugs may cost with a UnitedHealthcare Part D plan, and view a month-to-month explanation of those costs.

    Estimate drug costs  

    Additional resources and materials


    Explore articles for more in-depth information about Medicare Part D, so you can make confident decisions about your health insurance coverage.

    What to know about Medicare prescription drug costs with the end of VBID

    View info

    Understanding Medicare Part D deductibles

    Read more
    What is coinsurance?

    Understanding coinsurance

    Learn more

    Copay vs. Coinsurance: Understanding 2026 Medicare Part D Cost Changes

    Video transcript

    (bright subtle music)

     

    Medicare beneficiaries with Part D prescription drug coverage may notice changes to their costs in 2026.

     

    Since the Inflation Reduction Act took effect in 2025, many Medicare Advantage and Part D plans

    have moved from copays to coinsurance for drugs.

     

    So, let's walk through the differences. A copay is a flat amount you pay for a covered drug.

     

    Coinsurance is a percentage you pay of the total cost of a covered drug.

     

    For example, if a drug costs $100 and has a 25% coinsurance, you would pay $25

    and the plan pays $75.

     

    Your plan may have a deductible on certain drugs. Copays and coinsurance will apply

    after the deductible is met.

     

    The tier your drug is in will determine if you have a copay or a coinsurance.

    Copays are often applied to drugs in Tiers 1 and 2.

     

    Coinsurance is commonly found on drugs in Tiers 3, 4 and 5.

     

    Let's look at an example of coinsurance. Imagine you need to fill a Tier 3 drug that costs $800

    and has a coinsurance of 20%. Then, let's say your plan has a drug deductible of $615.

     

    Your first fill of the year would look like this. Because your drug cost is higher than the deductible amount,

    you'll owe the full $615. After you meet the deductible, there's $185 in drug cost remaining

    (800 minus 615 is $185).

     

    Of the remaining $185, you pay 20% coinsurance, which is $37. Then, your plan pays the rest.

     

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    This means that you will owe $652 for your first prescription fill.

     

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    Because you've already met the deductible for the year, your second fill will have a coinsurance cost of $160

    and your plan will pay the remainder of $640.

     

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    Drug costs may fluctuate from one day to the next and vary depending on the pharmacy.

     

    So, your coinsurance amount may be slightly different with each fill.

     

    Once you reach the $2,100 maximum out-of-pocket amount in 2026, you'll pay $0 for Medicare-covered
    Part D prescriptions for the rest of the year.

     

    To find out if your plan has coinsurance and what you may pay, review your 2026 plan materials,

    visit your member site or use the plan's app.

     

    As a UnitedHealthcare member, you can estimate your drug costs online so you feel confident about your coverage.

     

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    You can count on UnitedHealthcare to provide you with reliable Medicare information and support

    every step of the way.

     

    For more information on Medicare Part D, visit uhc.com/medicare.

     

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