What Medicare covers
Does Medicare cover prescription drugs?
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Short answer
Yes, Medicare covers prescription drugs through Part D: you get it by joining a stand-alone Part D drug plan alongside Original Medicare, or a Medicare Advantage plan that includes drug coverage.
In 2026, a Part D deductible can be no more than $615, and once your out-of-pocket spending on covered drugs reaches $2,100 you pay nothing more for covered drugs for the rest of the year; for 2027 those limits are $700 and $2,400.
A month's supply of covered insulin costs no more than $35, and vaccines recommended by the CDC's Advisory Committee on Immunization Practices have no cost sharing under Part D.
| Fact | Figure | Source |
|---|---|---|
| Out-of-pocket cap | $2,100 in 2026; $2,400 in 2027 | CMS |
| Maximum deductible | $615 in 2026; $700 in 2027 | CMS |
| Initial coverage stage | Generally 25% coinsurance for covered drugs until the cap | Medicare.gov |
| Insulin | No more than $35 for a month's supply of each covered insulin, no deductible | Medicare.gov |
| ACIP-recommended vaccines (such as shingles) | $0 under Part D | Medicare.gov |
| Late enrollment penalty | 1% of the national base beneficiary premium per month without creditable coverage | Medicare.gov |
How do I get Medicare drug coverage?
Two ways: a stand-alone Part D prescription drug plan (PDP) added to Original Medicare, or a Medicare Advantage plan that includes drug coverage (an MA-PD). Both are offered by private companies approved by Medicare. You can join when you first get Medicare and change plans each year from October 15 to December 7. Compare plans for your own drugs on the Medicare Plan Finder.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) is eliminated as of 2025 (three phases now). There’s now a hard yearly cap of $2,400 on what you pay out of pocket for covered drugs, and you can spread those costs across the year with the Medicare Prescription Payment Plan.
How do Part D costs work?
Part D has three stages. In the deductible stage you pay the full cost of covered drugs until you meet your plan's deductible (no more than $615 in 2026; some plans have none). In the initial coverage stage you generally pay 25% coinsurance, or the plan's copays, for covered drugs. Once your out-of-pocket spending reaches $2,100, catastrophic coverage starts and you pay nothing for covered Part D drugs for the rest of the calendar year. The old coverage gap (the "donut hole") ended in 2025.
Each plan has a list of covered drugs (a formulary), sorts drugs into tiers with different costs, and can charge less at preferred pharmacies. Plans can change their drug lists and costs each year; your Annual Notice of Change lists what changes on January 1.
Can I spread my drug costs over the year?
Yes. The Medicare Prescription Payment Plan lets you pay your out-of-pocket drug costs in monthly amounts across the year instead of all at once at the pharmacy. It doesn't lower what you owe, and it's free to join through your drug plan or Medicare Advantage plan.
Which drugs does Part B cover instead?
Part B covers some drugs you don't fill at a pharmacy, such as many drugs given by infusion or injection in a doctor's office, some oral cancer drugs, drugs used with certain medical equipment, and flu, pneumonia and COVID-19 shots and some hepatitis B shots. Insulin used with a pump is covered by Part B, also capped at $35 a month.
Is there help with drug costs?
Extra Help lowers Part D premiums, deductibles and copays for people with limited income and resources, and people who get it pay no Part D late penalty. Medicare has also negotiated lower prices for some high-cost drugs: which drugs and when. More: help paying for Medicare.
On this site: Medicare Part D plans by state
Good to know
More questions people ask
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Related questions
In depth
- Medicare.gov: Medicare drug coverage (Part D)
- Medicare.gov: Part D costs and coverage stages
- Medicare.gov: Insulin
- Medicare.gov: Help with drug costs (Extra Help)
Figures are Medicare’s, set nationally, and were checked against these pages on October 2026. For your own situation, contact Medicare.gov or 1-800-MEDICARE (TTY 1-877-486-2048).
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This page was last updated: October 2026.