Deductible Stage:
The amount you pay out-of-pocket before your plan begins to cover your prescription drug costs. Under 2026 guidelines, no Medicare drug plan may have a deductible higher than $615, and some plans feature a zero-dollar deductible.

Initial Coverage Stage:
You pay your plan’s copayment or coinsurance for covered medications (typically 25%), and the plan pays its share. This stage continues until your total out-of-pocket prescription costs reach the annual maximum cap.

Maximum Out-of-Pocket Cap ($2,100):
The traditional “Coverage Gap” (donut hole) has been completely eliminated. Once your personal out-of-pocket spending on covered Part D prescriptions hits exactly $2,100 for the 2026 plan year, you automatically bypass any further gaps.

Catastrophic Coverage Stage:
After you reach the $2,100 out-of-pocket threshold, you pay $0 for all covered formulary drugs for the remainder of the calendar year. Your copayments and coinsurance drop entirely to zero.

Note:
ALL INFORMATION IS FOR EDUCATIONAL PURPOSES AND DOES NOT CONSTITUTE PROFESSIONAL ADVICE. PLEASE TALK TO AN AGENT TO COMPARE PLANS.