Medicare Part D True Out-of-Pocket (TrOOP) Calculator
Estimate your true Medicare Part D out-of-pocket drug costs for 2026 — the donut hole is gone, replaced by a $2,100 spending cap.
The Medicare Part D donut hole no longer exists — it was eliminated in 2025. Instead, there's now a simple $2,100 out-of-pocket cap for 2026. Once you reach that amount in a year, you pay $0 for covered prescriptions for the rest of the year. This calculator shows how much you'll actually pay based on your estimated drug costs.
If you remember the old Part D "donut hole," here's the update: it's gone. Since January 1, 2025, Medicare Part D works through three simpler phases, a deductible, a coinsurance phase, and a catastrophic phase where your costs drop to zero. Enter your estimated annual drug costs below to see how much you'll actually pay out of pocket in 2026.
Estimate Your Part D Out-of-Pocket Cost
Total Estimated Out-of-Pocket Cost
Capped at $2,100 under the standard 2026 benefit — no matter how high total drug costs go, out-of-pocket spending can't exceed this amount.
Phase 1: Deductible
You pay 100% until the deductible is metPhase 2: Initial Coverage (25% Coinsurance)
You pay 25% until you reach the $2,100 capPhase 3: Catastrophic Coverage
Not reached this yearThis calculator assumes a simple 25% coinsurance rate throughout the initial coverage phase. In reality, for brand-name drugs, a manufacturer discount program contributes an additional 10% toward the cost that also counts toward the $2,100 cap, even though you don't pay that portion personally — this means people taking mostly brand-name drugs often reach catastrophic coverage (and $0 costs) faster than this simplified estimate shows. Treat this as a reasonable estimate, not an exact figure; actual plan cost-sharing (copays vs. coinsurance) varies by plan and drug tier.
Part D coverage now moves through three phases in a calendar year. First, the deductible phase: you pay full price for your prescriptions until you hit your plan's deductible, up to $615 in 2026, though many plans set it lower or skip it entirely. Second, the initial coverage phase: you pay 25% coinsurance on your drugs, while your plan and the drug manufacturer cover the rest. Third, catastrophic coverage: once your total out-of-pocket spending across both earlier phases reaches $2,100, you're done paying for the year. Every covered prescription after that point costs you $0. This cap is a genuinely large change from the old system. Before 2025, high drug costs could mean thousands of dollars a year in out-of-pocket spending with no ceiling. Now there's a hard stop. If your prescriptions are mostly brand-name drugs, you may reach that $2,100 cap even faster than this calculator estimates, since a manufacturer discount also counts toward your total even though you don't personally pay that portion.
Frequently Asked Questions
Does the Medicare Part D donut hole still exist?
No. The donut hole, also called the coverage gap, was eliminated starting January 1, 2025. It's been replaced by a simpler system: a deductible phase, an initial coverage phase, and a catastrophic coverage phase with a hard cap on what you pay.
What is the Medicare Part D out-of-pocket cap for 2026?
$2,100. Once your out-of-pocket spending on covered drugs reaches that amount, you enter catastrophic coverage and pay $0 for covered medications for the rest of the calendar year.
What is the Medicare Part D deductible for 2026?
Up to $615, though some plans charge less or have no deductible at all. This is the maximum a standard plan can charge before coverage begins.
How much coinsurance do I pay for Part D drugs?
25% during the initial coverage phase, after your deductible is met, until your total out-of-pocket spending reaches the $2,100 cap.
Will I definitely reach catastrophic coverage?
Only if your total drug costs are high enough. Many people with lower prescription costs never leave the initial coverage phase and simply pay 25% coinsurance (after the deductible) all year.
Does the Medicare Prescription Payment Plan (M3P) change how much I pay?
No, it doesn't change your total annual cost. M3P lets you spread your out-of-pocket Part D costs into monthly installments across the year instead of paying more at the pharmacy early on, which can help with cash flow.
This calculator provides a simplified estimate based on the 2026 Medicare Part D standard benefit design and does not constitute financial or insurance advice. It assumes a flat 25% coinsurance rate and does not account for plan-specific copay tiers, brand-name manufacturer discounts, or the Extra Help/Low-Income Subsidy program, all of which can change your actual costs. For your exact plan costs, check your Explanation of Benefits or contact your Part D plan directly.