The Inflation Reduction Act of 2022 has brought changes to how much people may have to pay for their prescriptions. Admittedly, it is complicated. Below is a link with information directly from the federal government.
2026 Medicare Part D Out-of-Pocket Cost Changes
Key points:
There are three phases:
- Deductible – patient has to pay for everything until the deductible is met. In 2026, it is $615. (for some plans, it may be less)
- Coverage phase– after the deductible is met, the patient has to pay %25 of the cost of medicines until the out-of-pocket maximum is reached. No more than $2100 total.
- Catastrophic phase – after a patient pays $2100, no more payments are needed for Part D covered drugs.
There is no more “donut hole.”
This will likely change again in 2027
These changes might not apply to plans where Medicare and private insurances are combined into a single plan, which are known as Medicare Advantage Plans. This does not directly impact people who have health insurance from their employer.
DR JOSHUA USEN 