Medicare drug coverage — Part D — is available two ways: built into a Medicare Advantage plan (an "MA-PD"), or as a stand-alone Prescription Drug Plan you add to Original Medicare. Either way, coverage comes from private insurers approved by Medicare, and each plan decides which drugs it covers, at what cost, and at which pharmacies.
The numbers for 2026 and 2027
| 2026 | 2027 | |
|---|---|---|
| Yearly out-of-pocket cap on covered drugs | $2,100 | $2,400 |
| Maximum standard deductible | $615 | $700 |
| Covered insulin cost-sharing | No more than $35/month per insulin | No more than $35/month per insulin |
| Recommended adult vaccines (like shingles) | $0 | $0 |
Source: CMS. Plans can have lower deductibles or none. The out-of-pocket cap counts what you and certain others (like Extra Help) pay toward covered drugs; premiums don't count.
Formularies and tiers
A formulary is the plan's list of covered drugs, usually grouped into tiers. Generics are typically on the lowest tiers; preferred brands, non-preferred drugs and specialty drugs cost more. Plans may require prior authorization, step therapy (trying a lower-cost drug first) or quantity limits. If a drug you need isn't covered, you or your prescriber can request an exception.
Smoothing out big pharmacy bills
The Medicare Prescription Payment Plan lets you spread out-of-pocket drug costs into monthly payments across the year instead of paying all at once at the pharmacy. It's free to join, available in all Part D plans (including Medicare Advantage plans with drug coverage), and especially helpful if you have high costs early in the year.
Extra Help
Extra Help is a program that helps people with limited income and resources pay Part D premiums, deductibles and copayments. People with Medicaid, a Medicare Savings Program or SSI qualify automatically. You can apply through Social Security at any time.
How we compare drug coverage
- We enter your medications, doses and quantities.
- We check which plans we offer cover each drug, at what tier and with what restrictions.
- We estimate your total yearly cost — premiums plus pharmacy costs — at your preferred pharmacy.
- We flag any drug that needs prior authorization or an exception.