Is there a cap on Medicare drug costs now?

Yes. Starting in 2025 and continuing in 2026, Medicare Part D has an annual out-of-pocket cap -- $2,100 in 2026. Once your covered prescription costs reach it, you pay $0 for covered drugs for the rest of the year.

What is Medicare Extra Help and do I qualify?

Extra Help (the Part D Low-Income Subsidy) pays your drug-plan premium and deductible and drops copays to a few dollars. In 2026 you may qualify with income up to about $23,940 for one person or $32,460 for a couple, plus limited savings. If you have Medicaid, an SSI check, or a Medicare Savings Program, you get it automatically.

How do I apply for Extra Help?

Apply free through Social Security at ssa.gov or by calling 1-800-772-1213. A SHINE counselor can help you apply at no cost. There's no harm in applying even if you're unsure -- many people who qualify never sign up.

Can I spread my drug costs over the year?

Yes. The new Medicare Prescription Payment Plan lets you pay your out-of-pocket drug costs in smaller monthly amounts across the year instead of all at once at the pharmacy. It's free to join and helps if big costs hit early in the year, though it doesn't lower your total.

What if I make too much for Extra Help?

You still have options: the annual $2,100 cap, the monthly payment plan, drug-maker patient assistance programs, comparing pharmacy prices, and asking about generics. A SHINE counselor can check your plan against your exact drug list every fall.

Who can help me for free?

SHINE -- Florida's free Medicare counseling program -- reviews your drugs and plan and helps you apply for Extra Help, at no cost. Reach it through the Elder Helpline.

Home › Paying for care › Prescription & drug-cost help

Ways to lower your Medicare drug costs

Prescriptions are one of the biggest worries in retirement, and there's real relief now -- a yearly cap, a program that wipes out costs for lower incomes, and a way to spread payments over the year. Here's how each one works and who helps for free.

Last reviewed: August 10, 2026

The short version:

There's finally a cap. In 2026, once your Part D out-of-pocket drug costs reach $2,100, you pay $0 for covered drugs the rest of the year.
Extra Help can wipe out most costs. Lower-income seniors pay no premium or deductible and only a few dollars per prescription.
You can spread payments. The Medicare Prescription Payment Plan turns big pharmacy bills into smaller monthly amounts, free to join.
SHINE helps for free. Florida's Medicare counselors review your drugs and plan and help you apply.
Ask about generics and patient-assistance programs -- they can cut costs further.

Common questions

Is there a cap on Medicare drug costs now?: Yes. Part D now has a yearly out-of-pocket cap -- $2,100 in 2026. Once your covered drug costs reach it, you pay $0 for covered drugs for the rest of the year.
What is Extra Help and do I qualify?: Extra Help (the Part D Low-Income Subsidy) pays your drug-plan premium and deductible and drops copays to a few dollars. In 2026 income limits are about $23,940 for one person or $32,460 for a couple, with limited savings. Medicaid, SSI, and Medicare Savings Program members get it automatically.
How do I apply for Extra Help?: Apply free through Social Security at ssa.gov or 1-800-772-1213, or have a SHINE counselor help at no cost. Many people who qualify never sign up, so it's worth applying.
Can I spread my drug costs over the year?: Yes. The Medicare Prescription Payment Plan lets you pay out-of-pocket drug costs in smaller monthly amounts instead of all at once. It's free to join and helps when costs hit early in the year, though it doesn't lower your total.
What if I make too much for Extra Help?: You still have the $2,100 cap, the monthly payment plan, drug-maker assistance programs, pharmacy price comparisons, and generics. A SHINE counselor can match your plan to your exact drug list each fall.
Who can help me for free?: SHINE, Florida's free Medicare counseling program, reviews your drugs and plan and helps you apply for Extra Help. Reach it through the Elder Helpline.

The yearly cap on drug costs

For years there was no ceiling on what Part D could cost you. Now there is. In 2026 your out-of-pocket costs for covered drugs are capped at $2,100. After you hit it, covered prescriptions cost you nothing for the rest of the calendar year. You don't sign up for the cap -- it's automatic in every Part D plan.

Extra Help: the biggest saver

Extra Help (also called the Part D Low-Income Subsidy) is the program that helps most. It eliminates the drug-plan premium and deductible and cuts copays to just a few dollars. In 2026 you may qualify with income up to roughly $23,940 (single) or $32,460 (couple), with savings under about $18,090 or $36,100. If you already have Medicaid, an SSI payment, or a Medicare Savings Program, you're enrolled automatically. Apply free at ssa.gov or by calling 1-800-772-1213.

Spread the cost: the Medicare Prescription Payment Plan

If a costly prescription lands all at once, the Medicare Prescription Payment Plan lets you pay it off in smaller monthly installments over the year instead of at the pharmacy counter. It's free to join and free to cancel, and every Part D plan must offer it. It doesn't reduce your total, but it smooths out the timing -- helpful when big costs hit in January.

Other ways to cut the bill

Medicare Savings Programs help pay your Medicare premiums, and can open the door to Extra Help. Ask through the Elder Helpline.
Drug-maker patient assistance programs give some brand-name medicines free or at low cost to people who qualify.
Ask about generics and compare pharmacy prices -- the same drug can cost very different amounts at different pharmacies. Your pharmacist can help.
Review your plan every fall. Plans change their drug lists and prices, so the right plan for your medicines can change year to year.

Sources

Medicare -- Costs & the yearly out-of-pocket cap; Medicare Prescription Payment Plan. https://www.medicare.gov/prescription-payment-plan
Social Security Administration -- Extra Help with Medicare prescription drug costs. https://www.ssa.gov/medicare/part-d-extra-help
Centers for Medicare & Medicaid Services -- Medicare Prescription Payment Plan. https://www.cms.gov/medicare/health-drug-plans/medicare-prescription-payment-plan
National Council on Aging -- Part D Low-Income Subsidy (Extra Help). https://www.ncoa.org/article/understanding-medicare-part-d-low-income-subsidy-lis-extra-help/

Please read: Nature Coast Senior Home is an independent guide, not an insurer or the government, and this is general information, not advice. Program amounts and income limits change every year -- confirm your numbers with Medicare, Social Security, or a free SHINE counselor before you decide. We don't collect or sell your information.