Medicare Part D Explained 2026: The New $2,100 Cap, Formularies and Drug Tiers

With Medicare Part D, the plan with the lowest premium is very often not the plan that costs you the least. Your medications decide that — the exact drug, the dosage, the tier it sits on and the pharmacy you use. David Heitner walks through how Part D actually works in 2026, including the new $2,100 annual cap on what you pay for covered drugs, and why two spouses in the same house can be better off on two completely different plans. In this video: 0:00 - Why your medications decide the plan 1:03 - What Medicare Part D is 1:49 - What a formulary is 2:26 - Drug tiers 3:06 - Why your pharmacy changes the price 3:53 - What Part D costs in 2026 4:34 - The new $2,100 out-of-pocket cap 5:25 - The donut hole is gone 6:16 - The Medicare Prescription Payment Plan 7:02 - Prior authorization, step therapy and quantity limits 7:55 - Insulin and vaccines 8:40 - Why two spouses may need different plans 9:27 - Don't pick a plan on premium alone 10:07 - Review your plan every year 10:56 - What to have ready before we compare 11:34 - What's next: when to enroll This is Episode 7 of an ongoing series. Episode 1 covers the foundation, Episode 2 goes deeper on Part A, Episode 3 covers Part B, Episode 4 covers Medicare Supplement insurance, Episode 5 covers Medicare Advantage, and Episode 6 compares the two paths side by side. Episode 8 covers enrollment timing. The 2026 Part D figures used in this video: Maximum deductible under the standard benefit: $615 (plans may charge less, or none) Annual out-of-pocket limit for covered Part D drugs: $2,100 Covered insulin: capped at $35 for a month's supply of each product, or 25% of the negotiated price, whichever is less Recommended adult vaccines covered under Part D: $0 cost-sharing All figures are 2026 amounts and change each year. Worth knowing: the Part D "donut hole" coverage gap ended after December 31, 2024. If someone explains today's Part D using the old four-stage model with a coverage gap, they are describing a system that no longer exists. For 2026 the standard benefit moves through a deductible stage, an initial coverage stage, and then catastrophic coverage once the out-of-pocket threshold is reached. FREE GUIDE - Medicare Insurance Basics (PDF): https://drive.google.com/file/d/1GHbM... More Medicare resources: https://heitsbenefits.com/medicare/?u... Questions about your own situation: Call or text (201) 647-2095. Heits Benefits Group does not offer every plan available in your area. Any information provided is limited to the plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options. Not connected with or endorsed by the U.S. Government or the federal Medicare program. David Heitner, National Producer Number 2098121 #Medicare #MedicarePartD #PrescriptionDrugCoverage #Medicare2026 #DonutHole #TurningSixtyFive #MedicareExplained #HeitsBenefits Securities and advisory services offered through Independent Financial Group, LLC (IFG), a Registered Investment Adviser. Member FINRA/SIPC. Heits Benefits Group and IFG are unaffiliated entities. OSJ Branch: 12671 High Bluff Dr. Suite 200. San Diego, CA 92130 IFG Registered Representatives associated with this website may discuss and/or transact business only with residents of the states in which they are properly registered or licensed. Some insurance products are offered outside of the existing Broker Dealer relationship. The information provided is from sources believed to be reliable however, we cannot guarantee or represent that it is accurate or complete. Because situations vary, any information provided on this site is not intended to indicate suitability for any investor. Hyperlinks are provided as a courtesy and should not be deemed as an endorsement. When you link to a third-party website you are leaving our site and assume total responsibility for your use or activity on the third-party sites.