Document 1 - Summary: Medicare Prescription Payment Plan (2026)
High-level overview for leaders and clinicians.
Print this page for staff education.
What it is
The Medicare Prescription Payment Plan is a voluntary payment option offered by all Medicare drug plans and Medicare health plans with drug coverage.
Participation has no fee and changes the timing of payment, not the total covered Part D drug cost. The plan bills the participant monthly for covered Part D out-of-pocket costs.
What it is not
- It is not a discount program
- It does not lower the total cost of medications for the year
- It only changes when and how patients pay
Key 2026 numbers
- Maximum Part D deductible: $615
- Annual out-of-pocket maximum for covered Part D drugs: $2,100
- After reaching the out-of-pocket maximum, patients do not pay out-of-pocket for covered Part D drugs for the rest of the calendar year
How it works
- The patient keeps their Medicare drug coverage
- The patient continues to pay any monthly plan premium
- For covered Part D drugs, the patient usually does not pay the pharmacy
- The Medicare drug plan sends the patient a monthly bill for prescription costs
- Monthly bills may change during the year, especially if medications change
When it may be most helpful
- Patients with high prescription costs earlier in the year
- Patients who want to avoid large pharmacy payments
When it may be less helpful
- Patients with low yearly drug costs
- Patients whose drug costs are the same each month
- Patients enrolling late in the year, especially after September
- Patients who receive other assistance that already lowers drug costs, such as Extra Help
Enrollment basics
- Enrollees request participation through their Medicare drug plan by phone, paper, or the plan's website
- The plan sponsor processes the election
- Enrollment can happen at any time during the year
- By law, Medicare drug plans are required to offer this program and help patients enroll