Medicare Prescription Drug Plan 2026 FAQs

When will I be billed or charged for my plan? 

Most Medicare Prescription Drug Plan carriers don’t charge for their plans until the beginning of January, after new plans are activated. It could be the middle of the month before you see your billing or before you see a bank draft withdrawn. Keep an eye on your bank account, your drug plan portal, or call the number on the back of your card to get exact dates.   

I asked that my Medicare Prescription Drug Plan payment be withdrawn from my Social Security check, when will that happen? 

It usually takes 1-2 months for Social Security to send the money to Medicare for your plan.

During that time, you will get a bill from the carrier, and you should pay it until you see a statement that it is being withdrawn from Social Security.  If any duplicate payments are made, they will be refunded.  

I set up a coupon book or billing from my Medicare Prescription Drug Plan carrier and haven’t received it yet.  When will that come? 

The carriers send out billing after the first of the year and you have a grace period to get your plan paid. If you haven’t received your billing by the 15th of the month, call the number on the back of your card and ask them when it was sent. You can also request another coupon book.  

My Medicare Prescription Drug Plan premium is so low, can I pay more than one month at a time? 

Yes! You can pay for the entire year or as many months as you need by asking for a coupon book or billing or going to your customer portal to set up your preferred payment method.  

I want to change my payment method for my Medicare Prescription Drug Plan. Can I do that? 

Yes! You will need to call the number on the back of your card, and they can take payment over the phone and/or change your payment method. Some carriers allow a credit card payment, but you must call to set it up.  

Or if you have set up your customer portal, you can usually make changes there.  

I went to the pharmacy, and I was charged a huge amount for my refill(s). Why? 

Deductibles reset every year in January, so the first time you refill a brand name drug (usually tiers 3-5), then you are charged the retail cost until that deductible is met. For 2026 the allowable deductible is $615 per year. Carriers can charge less or no deductible, so understanding what your deductible is will help alleviate the sticker shock at the beginning of the year or when you first refill your higher tiered medications.

Note that beginning in 2025 you will be able to opt into a prescription payment plan (PPP) with your carrier.  You must do this before you go to the pharmacy to pick up your prescriptions by calling your carrier or going to your user portal to set it up.

Annual cap is now $2100

Diabetic medications are now capped at $35/month for covered insulin.

I take an expensive medication and reached the “donut hole” in previous years. How will I know when to expect that this year? 

Thanks to the Inflation Protection Act beginning in 2025 there is an annual cap of $2000  on out-of-pocket costs for people on a Part D plan. So there is no longer a gap or donut hole.  This only applies to drugs that are on the carrier’s formulary, so it’s important to make sure your medications  will be covered by this cap on your plan.   

This year, some diabetic mediations are capped at $35/month for covered insulin. Note that not all drug companies have every insulin at a reduced cost.  Be sure to check your formulary for the discounted insulins that your plan covers.  

I changed my Medicare Prescription Drug Plan and want to use the same mail order service. Can I do that? 

If you have the same carrier, then yes. If you changed carriers, then no. You will need to use your current carrier’s mail order service. Sometimes the costs are lower by using mail order, so it may be worth investigating. Also, pharmacies often have their own programs that offer 90-day pricing, so check with them to see what your costs would be.  

I don’t like my Medicare Prescription Drug Plan.  Can I drop it or change it? 

You can only change your plan during the Annual Enrollment Period which is from Oct. 15 – Dec 7th every year and the new plans run for a calendar year.  There are many strategies to lower costs and we at McCormack Consulting Group, Inc work with our clients to help them implement an appropriate strategy.  Sometimes it means changing medications, using a manufacturer coupon or government subsidies such as Medicaid or the Low-Income Subsidy (LIS) program. And then during AEP changing your plan  to one that covers your medications.   

If you drop your drug plan in the middle of the year, you will be penalized for all the months that you went uncovered by a credible drug plan when you next re-enroll.  

If you have any additional questions, contact our team at McCormack Consulting Group, Inc today!