By Patricia Prewitt
My Personal Rx Adviser
The health care market and prescription coverage continue to evolve with policy changes still being formalized. As of mid-December 2025, uncertainty remains as to subsidies and tax credits for employers. The number of insurance plans covering stand-alone Medicare Part D prescription plans dropped nationally by 22%. Here in Massachusetts, stand-alone Medicare Plan D plans dropped from 16 to 11. The Medicare Advantage Plans (Type C ) have continued to gain in popularity. Hopefully, the readers of this publication carefully evaluated choices for 2026 in conjunction with formulary coverage for their own medications lists.
What would I expect to budget for my prescriptions in 2026 on Medicare?
The standard annual deductible for Medicare Part D drug plans increased from $590 to $615. Your deductible may be less, depending on your type of insurance prescription coverage. An average monthly premium for a Medicare Part D plan runs about $35 a month. In 2026, the annual cap for out-of-pocket costs for covered prescriptions is $2,100. This is good news for many people, as long as your chosen prescription plan covers the medications you need.
What is a good way to budget for high prescription costs at the beginning of the year?
Medicare now allows subscribers to smooth drug costs across the year rather than paying that high deductible cost early in the year. If your medical conditions require brand or high cost products to keep you healthy, choose opt-in for the payment option to spread costs over the course of 12 months.
Why are some of my prescriptions not covered by my Medicare prescription plan?
The list of covered medications, tiers, and formularies changes annually by insurance companies. This is why it is critically important to review plans between October 15 – December 7, the open enrollment period, to make changes that fit your needs. Prescriptions “not covered” most often include lifestyle products for weight management, hair loss, hormones, and sexual health prescriptions. Be prepared to pay the full retail costs for these medications. The out-of-pocket costs typically will not accrue to any deductible.
How would you suggest I pay for expensive, not covered medications?
Shop for the best price you can find. If you have a Health Savings Account, submit receipts for approval to use money you saved for uncovered medical expenses. Check for savings cards, which may offer some relief. If the product is not a lifestyle medication, there may be a patient assistance program that could help.
What happens if I make a mistake in choosing my prescription plan? Is there anything I can do?
Here in Massachusetts, we have some consumer protections that allow for changes. There is a Medicare Advantage Open Enrollment period from January 1-March 31. A licensed Medicare insurance broker or agent can help facilitate a change or return to original Medicare. There is also a Special Enrollment Period (SEP) that allows changing plans if you have moved, for example.
Prescription Advantage, a state entity, may be able to assist with prescription plan changes; call 800-243-4636 (Option 3).
Content provided is for educational purposes only and is not intended as a substitute for advice from a qualified medical professional. The opinions expressed within are those of the author.
About the Author: Patricia Prewitt is a local Massachusetts resident who spent more than 30 years in the pharmaceutical industry. Tricia is a consumer education advocate, and loves helping people find ways to save money on their prescriptions. More information and free resources are available on her website at https://mypersonalrxadvisor.com/resources or call her at 508-507-8840. Favorite Quote: “Act as if what you do makes a difference. It does.” – William James
