The 2026 Part D structure
| Stage | What you pay (2026) |
|---|---|
| Yearly deductible | Up to $615, depending on the plan; some plans have a lower deductible or none |
| Initial coverage | The plan's copays or coinsurance, until your out-of-pocket costs reach $2,100 |
| Catastrophic coverage | Nothing for covered Part D drugs for the rest of the year |
The "donut hole" coverage gap was eliminated by the Inflation Reduction Act: since 2025 there is no coverage gap, and the out-of-pocket cap ($2,000 in 2025, $2,100 in 2026) is a single ceiling on what you pay for covered drugs. You still pay your plan's monthly premium. For 2027 amounts, see Medicare costs in 2027.
Smoothing your costs across the year
The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs into monthly payments through the year, instead of paying the full amount at the pharmacy when you fill an expensive prescription. The total you pay in the year is the same; only the timing changes. It costs nothing extra to join and doesn't charge interest. It's optional; contact your plan to sign up, and you can join before or during the year.
Insulin and vaccines
Covered insulin costs no more than $35 for a month's supply of each covered insulin product, in standalone Part D plans and in Medicare Advantage plans with drug coverage, and the deductible doesn't apply. Adult vaccines recommended by the CDC's Advisory Committee on Immunization Practices (ACIP), such as shingles, RSV and Tdap, cost you nothing under Part D.
Programs that lower drug costs in Washington
Extra Help (Low-Income Subsidy)
If your income is at or below 150% of the federal poverty level ($23,940 a year for one person in 2026) and your resources are within the limits, Extra Help pays most or all of your Part D premium and deductible and limits your copays. Apply at ssa.gov. See our Extra Help page.
Medicare Savings Programs
Washington's Medicare Savings Programs pay the Part B premium for people with income up to 138% of the federal poverty level, with no asset test, and anyone approved gets Extra Help automatically. Apply through Washington Connection. See Medicare Savings Programs in Washington.
Apple Health for people with both
If you qualify for both Medicare and full Apple Health (Medicaid), Apple Health pays your Part B premium and Medicare cost sharing, and you automatically get Extra Help. People with both can look at a dual special needs plan (D-SNP), which coordinates the two.
Manufacturer assistance and 340B pharmacies
Many drug manufacturers run patient assistance programs for specific medicines; ask your prescriber or the manufacturer. Some community health centers and tribal health programs in Washington take part in the federal 340B drug pricing program, which can lower what their pharmacies charge for some prescriptions; ask whether yours does. See Tribal health and Medicare.
Washington's ArrayRx discount card
The Health Care Authority's Washington Prescription Drug Program offers the ArrayRx discount card. Any Washington resident can sign up at no cost, with no age or income limits. HCA says Medicare beneficiaries who don't have Part D coverage can use it, but it can't be combined with Medicare pharmacy benefits or used to cover a copay from your plan; at the pharmacy you choose either the card or your coverage, whichever costs less. It's a discount program, not insurance, and it doesn't replace Part D or protect you from the Part D late enrollment penalty.
Local aging services
Washington's Area Agencies on Aging, reachable through Community Living Connections, can connect you with local aging and long-term care services and help with applications for programs like the Medicare Savings Programs.
Comparing Part D plans in Washington
Your specific drugs and doses drive plan choice. Two plans can charge very different amounts for your medicines because drug lists, tiers and pharmacy networks differ. For 2027, 4 companies offer 8 standalone Part D plans in Washington (CMS data), and the Annual Enrollment Period for 2027 coverage runs October 15 to December 7, 2026. Use Medicare.gov's Plan Finder with your prescriptions and the Washington pharmacy you actually use. If your Medicare Advantage plan ends on December 31, 2026, see Washington Medicare plans ending in 2027.
A licensed insurance agent with Benefits Life can check your prescriptions against plans from the companies they work with, at no cost to you. Call (206) SENIORS (206-736-4677), TTY 711, or see plans in your ZIP code. Learn more on Medicare Part D in Washington.
Sources
- Medicare.gov — Costs for Medicare drug coverage
- Medicare.gov — Medicare Prescription Payment Plan
- CMS — CY 2026 Rate Announcement (Part D benefit parameters)
- Medicare.gov — Help with drug costs (Extra Help)
- Washington Health Care Authority — Medicare Savings Program
- Washington Health Care Authority — Get help paying for prescriptions (ArrayRx discount card)
- HRSA — 340B Drug Pricing Program
- CMS — CY2027 Landscape file, November 2026 (Washington standalone Part D plan and company counts)
Frequently asked questions
Does the Part D out-of-pocket cap reset every year?
Yes. Your out-of-pocket total starts over on January 1. The cap is $2,100 in 2026, and federal law adjusts it each year with growth in Part D drug spending; see Medicare costs in 2027 for next year's amount.
Does insulin count toward the cap?
Yes. What you pay for covered insulin, no more than $35 for a month's supply of each covered insulin, counts toward the yearly out-of-pocket cap, and the plan's deductible doesn't apply to it.
If I have a Medicare Advantage plan with drug coverage, do I get the cap too?
Yes. The out-of-pocket cap applies to Part D coverage whether it comes from a standalone drug plan or from a Medicare Advantage plan that includes drug coverage.
Can I switch Part D plans mid-year?
Generally only during the Annual Enrollment Period (October 15 to December 7) or with a Special Enrollment Period, such as when you move, gain or lose Apple Health, or your plan ends. People with Extra Help or Apple Health can switch to a different standalone Part D plan once a month.
Medicare in your Washington county
Plans, local agents and help, county by county: Adams · Asotin · Benton · Chelan · Clallam · Clark · Columbia · Cowlitz · Douglas · Ferry · Franklin · Garfield · Grant · Grays Harbor · Island · Jefferson · King · Kitsap · Kittitas · Klickitat · Lewis · Lincoln · Mason · Okanogan · Pacific · Pend Oreille · Pierce · San Juan · Skagit · Skamania · Snohomish · Spokane · Stevens · Thurston · Wahkiakum · Walla Walla · Whatcom · Whitman · Yakima
