The big news: a hard out-of-pocket cap
For most of its history, Medicare Part D had no yearly out-of-pocket maximum. People with expensive medicines could owe thousands of dollars a year even with coverage. That changed in 2025, and for 2026 the cap is $2,100.
Once your out-of-pocket spending on covered Part D drugs reaches $2,100 in a calendar year, you pay nothing more for covered drugs for the rest of that year. That's one of the most significant changes to Medicare in a generation, and it matters for Washington residents managing chronic conditions, cancer treatment or other costly prescriptions. The cap and deductible for 2027 are on our 2027 Medicare costs page.
How Part D works
Part D plans are sold by private insurance companies that contract with Medicare. You can get Part D in two ways:
- A standalone Part D plan (PDP) paired with Original Medicare (and, if you choose, a Medigap policy)
- Built into a Medicare Advantage plan (a Medicare Advantage Prescription Drug plan, or MAPD)
You can't have two Part D plans at the same time. If you join a standalone Part D plan while you're in a Medicare Advantage plan that includes drug coverage, you'll generally be disenrolled from the Medicare Advantage plan and returned to Original Medicare.
Standalone Part D plans in Washington for 2027
For standalone drug plans, Medicare treats all of Washington as a single region, so the same plans are offered in every county, from King to Garfield. CMS's 2027 plan data shows 8 standalone Part D plans from 4 companies in Washington. Medicare Advantage plans with drug coverage are different: they vary by county. See Medicare Advantage in Washington and your county's page.
Plans change every year. If you're in a standalone drug plan now, read the Annual Notice of Change your plan sends each fall, and review your options during the Annual Enrollment Period.
How Part D costs work in 2026
| Stage | What happens | You pay |
|---|---|---|
| Deductible | Until you meet your plan's deductible (no more than $615 in 2026) | The full cost of your drugs, up to the deductible (some plans have a lower deductible or none) |
| Initial coverage | After the deductible, until your out-of-pocket costs reach $2,100 | Your plan's copayments or coinsurance for each drug |
| Catastrophic coverage | After you've paid $2,100 out of pocket | $0 for covered drugs for the rest of the year |
Notice what's missing: the "donut hole" coverage gap, which used to raise costs in the middle of the year, ended in 2025 as part of the same changes. Covered insulin costs no more than $35 for a month's supply, and you pay nothing for recommended adult vaccines covered by Part D.
Medicare Prescription Payment Plan
Since 2025, you can choose to pay your Part D out-of-pocket costs in monthly installments over the calendar year instead of all at once at the pharmacy. This is called the Medicare Prescription Payment Plan.
For example, if you fill an expensive prescription early in the year, you don't pay the whole amount at the counter; your plan bills you for it in monthly amounts over the rest of the year. You still owe the same total, but your costs are spread out. There's no fee or interest.
It's optional, and you sign up by contacting your Part D plan (or your Medicare Advantage plan, if your drug coverage is part of it). It tends to help most when you have high costs early in the year, such as with some cancer or specialty drugs. If you get Extra Help, it's usually not the better choice for you.
Choosing a plan in Washington
Which plan fits you depends on which medicines you take and which pharmacies you use.
Formulary matching
Every Part D plan has a formulary, the list of drugs it covers and the tier each one is on. Two plans might both cover the same medicine at very different costs to you. Check your medicines against a plan's formulary before you join.
Medicare's Plan Finder at medicare.gov/plan-compare lets you enter your medicines and pharmacy and see estimated yearly costs for the plans available in your ZIP code. You can also see plans in your ZIP code here.
Pharmacy networks
Many Part D plans have preferred pharmacies where your costs are lower. If you rely on a particular pharmacy, which is common in smaller towns such as Walla Walla, Wenatchee or Pomeroy, check whether it's in each plan's network and whether it's preferred.
Many plans also offer mail-order pharmacy, which can be convenient for medicines you take every day, especially if you live far from a pharmacy.
Extra Help (Low-Income Subsidy)
Washington residents with limited income and resources may qualify for Extra Help, a federal program that helps pay Part D premiums, deductibles and copayments. Since 2024, people with incomes up to 150% of the federal poverty level who meet the resource limit get the full benefit. In 2026, that's an income of up to $23,940 a year for a single person or $32,460 for a married couple living together.
With Extra Help in 2026, you pay no Part D deductible and no more than $5.10 for each covered generic drug and $12.65 for each covered brand-name drug.
You get Extra Help automatically if you have full Apple Health coverage, a Medicare Savings Program or Supplemental Security Income (SSI). Otherwise, you can apply online through Social Security. More on Extra Help →
Late enrollment penalty
If you go 63 or more days in a row without Part D or other creditable drug coverage after your Initial Enrollment Period ends, you'll generally owe a Part D late enrollment penalty for as long as you have Part D. It's 1% of the national base beneficiary premium ($38.99 for 2026) for each full month you went without coverage, rounded to the nearest 10 cents. How late penalties work →
Many Washington residents delay Part D because they have creditable drug coverage from somewhere else: VA benefits, retiree drug coverage from PEBB or a former employer, TRICARE, or Indian Health Service and tribal pharmacy benefits. If your other coverage is creditable (your plan sends a yearly notice saying so), no penalty applies.
For VA pharmacy users
VA drug coverage is creditable, so veterans who use VA pharmacies, including those at VA Puget Sound, Spokane and Walla Walla, don't need Part D to avoid a penalty. Some veterans join a Part D plan anyway, for example to fill prescriptions at a local pharmacy from a non-VA doctor. More for veterans →
Changing Part D plans
You can change Part D plans:
- Annual Enrollment Period (October 15 – December 7; changes take effect January 1)
- Medicare Advantage Open Enrollment Period (January 1 – March 31), if you're in a Medicare Advantage plan and want to switch plans or go back to Original Medicare and join a standalone drug plan
- Special Enrollment Periods for qualifying events, such as a move, losing other coverage, your plan leaving Medicare, or a declared disaster. If you have Apple Health or Extra Help, you can make certain changes to your drug coverage once a month.
Reviewing your Part D coverage every year during the Annual Enrollment Period is one of the most useful things you can do: formularies, premiums and pharmacy networks change every year, and the plan that fit you in 2026 may not fit in 2027.
To talk through drug plans from the companies they work with, call (206) SENIORS (206-736-4677), TTY 711 to reach a licensed insurance agent with Benefits Life, at no cost to you.
Sources
- CMS — CY2027 Medicare Advantage and Part D Landscape files
- Medicare.gov — Drug coverage (Part D)
- Medicare.gov — Costs for Medicare drug coverage
- Medicare.gov — Medicare Prescription Payment Plan
- Medicare.gov — Part D late enrollment penalty
- Social Security — Extra Help with Medicare prescription drug plan costs
- CMS — CY 2026 resource and cost-sharing limits for the Low-Income Subsidy
- Medicare.gov — Special Enrollment Periods
Frequently asked questions
What is the Part D out-of-pocket cap for 2026?
For 2026, once you've paid $2,100 out of pocket for covered Part D drugs, you pay nothing more for covered drugs for the rest of the year. The 2027 cap is listed on our 2027 Medicare costs page.
What is the maximum Part D deductible for 2026?
The highest deductible a Part D plan can have in 2026 is $615. A plan can set a lower deductible or none, so check each plan's details before you choose.
Can I delay Part D if I have VA pharmacy benefits?
Yes. VA drug coverage counts as creditable coverage, so you can delay Part D without a late penalty as long as you keep it. If you ever lose or drop VA coverage, you have 63 days to join a Part D plan without a penalty.
What happens if I miss my Part D enrollment window?
If you go 63 days or more in a row without Part D or other creditable drug coverage after your Initial Enrollment Period ends, you'll generally owe a late enrollment penalty when you join: 1% of the national base beneficiary premium for each full month you were without coverage, added to your premium for as long as you have Part D.
How do I qualify for Extra Help?
Extra Help is based on income and resources. In 2026, the income limit is $23,940 a year for a single person, and the resource limit is $16,590. You're automatically eligible if you have full Apple Health, a Medicare Savings Program or SSI; otherwise you apply through Social Security.
Medicare in your Washington county
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