Big Part D changes kicked in for 2025, and they keep evolving for 2026. Use September to review your Annual Notice of Change (ANOC) (arrives by Sept 30) and prep for the fall shopping season.
The headline numbers
- 2025: Your out-of-pocket (OOP) spending on Part D drugs is capped at $2,000 for the year.
- 2026: The OOP threshold is $2,100 (the 2025 cap, indexed). Once you hit it, you owe $0 for covered Part D drugs the rest of the year—no 5% “catastrophic” coinsurance anymore.
How the redesigned benefit works
- Three phases (Deductible → Initial Coverage → Catastrophic). The old “donut hole” discount program is sunset under the redesign.
- Monthly payment option: The Medicare Prescription Payment Plan lets you spread your drug costs into capped monthly bills so big refills don’t wreck a single month’s budget. (It doesn’t reduce total cost—just smooths it out.)
What to do in September
- Open your ANOC. Circle any 2026 changes to premiums, deductibles, your drug tiers, and preferred pharmacies. Plans must deliver ANOCs by Sept 30.
- Make a fresh med list (name, dose, frequency) and note any new brand-name drugs.
- Estimate 2026 costs using your plan’s tools or Medicare’s Plan Finder once 2026 data is posted—especially if you’re likely to hit the cap.
- Consider the payment plan if you have hefty early-year fills; it can help cash flow even if you never reach the OOP cap.
Why this matters even if you don’t take many meds
Formularies and pharmacy networks change every year. A plan that was perfect in 2025 could shift tiers or drop a preferred pharmacy in 2026. The ANOC is your early warning—and AEP runs Oct 15–Dec 7 if you need to switch.
Have questions about your ANOC, the $2,100 cap, or whether the monthly payment plan makes sense for you?
That’s what your broker is here for—reach out anytime and we’ll compare your 2026 options side-by-side.