Quick Answer: No, Original Medicare (Parts A and B) does not cover most outpatient prescription drugs on its own. Prescription drug coverage comes through Medicare Part D, either as a standalone Prescription Drug Plan paired with Original Medicare, or bundled into a Medicare Advantage plan. In 2026, Part D has a simplified three-phase structure with a $2,100 annual out-of-pocket cap, and the old “donut hole” coverage gap has been eliminated.
If you assumed Medicare automatically covers your prescriptions the way it covers a doctor’s visit, you’re not alone, and you’re also not quite right. Original Medicare was built around hospital and medical care, and outpatient prescription drugs were added later, in 2006, as a separate piece called Part D.
Understanding how Part D works matters more this time of year than almost any other, since Annual Enrollment is when most people either pick a drug plan for the first time or find out their current one no longer covers what they need. Below, I’ll walk through what Part D actually covers, how the 2026 cost structure works now that the coverage gap is gone, what a formulary is, and how to think about choosing the right plan for your medications.
Does Medicare Cover Prescription Drugs?
Not through Original Medicare alone. Part A and Part B cover drugs administered in a hospital or doctor’s office, like an infusion or a vaccine given during a visit, but they don’t cover the prescriptions you pick up at a pharmacy and take at home. That coverage comes through Medicare Part D.
Part D is entirely run by private insurance companies approved by Medicare, not the government directly. You get it one of two ways: a standalone Prescription Drug Plan (PDP) added to Original Medicare, or a Medicare Advantage plan that bundles drug coverage in, often called an MA-PD. In 2026, Medicare Advantage remains the primary source of Part D coverage nationally, with standalone PDP enrollment also growing.
What Does Medicare Part D Actually Cover?
Part D covers self-administered outpatient prescription drugs, meaning the pills, injectables, and other medications you take yourself at home, along with certain vaccines like the shingles and Tdap vaccines. Exactly which drugs are covered, and at what cost, depends on your specific plan’s formulary.
What Is a Formulary?
A formulary is your plan’s official list of covered drugs, and it’s the single most important document for anyone choosing a Part D plan. Every plan builds its own formulary, organizing drugs into cost tiers, typically ranging from low-cost generics to specialty drugs, with your copay or coinsurance rising at each tier.
Formularies aren’t static. Plans can adjust which drugs they cover and at what tier from year to year, and in 2026 that management has tightened somewhat, with slightly reduced coverage for some top brand-name drugs and a continued shift from flat copays toward percentage-based coinsurance. This is exactly why checking your plan’s formulary every year during Annual Enrollment matters, even if you’re happy with your current plan.
A Trade-Off Worth Understanding
A plan with a low monthly premium can still cost you far more overall if your specific medications sit on a high formulary tier or require prior authorization. The premium is only half the picture. The other half is whether your actual medications are covered, and at what cost, which is why comparing plans based on your medication list matters more than comparing plans based on price alone.
How Much Does Medicare Part D Cost in 2026?
Part D costs now follow a simplified three-phase structure. In the deductible phase, you pay 100% of your drug costs up to your plan’s deductible, capped at $615 in 2026 for plans that charge one. In the initial coverage phase, you pay copays or coinsurance based on your formulary tier. Once your total out-of-pocket spending reaches $2,100 for the year, you enter the catastrophic phase, where you pay $0 for covered drugs for the rest of the year.
Covered insulin is capped at $35 for a one-month supply across all phases except catastrophic coverage, where it drops to $0. If managing a large payment is difficult, the Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs into predictable monthly installments instead of paying at the pharmacy counter.
What Happened to the Donut Hole?
If you’ve had Medicare for a while, you may remember the “donut hole,” a coverage gap where costs spiked once you hit a certain spending threshold. That gap was eliminated starting in 2025 and remains gone in 2026, replaced by the simplified three-phase structure and the $2,100 out-of-pocket cap described above. If your drug spending used to jump partway through the year, that specific problem no longer exists.
How Do You Choose the Right Part D Plan?
The single most effective thing you can do is start with your actual medication list rather than a plan’s advertised premium. A plan can look inexpensive on paper and still cost you significantly more over the year if it doesn’t cover your specific prescriptions well.
A Real Scenario Worth Considering
Say you’re in Tulsa taking a maintenance medication for a chronic condition plus an occasional generic. One plan might have a low premium but place your maintenance drug on a high coinsurance tier, while another plan with a slightly higher premium covers that same drug at a flat, low copay. Over 12 months, the second plan could easily save you hundreds of dollars, even though it looked more expensive at first glance.
Because formularies and pricing change every year, it’s worth reviewing your specific medications against your plan’s options before Annual Enrollment closes, rather than assuming last year’s plan is still your best option. This is exactly the kind of comparison I help clients in the Tulsa area work through every fall. If you’d like help, bring your medication list and we’ll find the plan that covers them for less. You can schedule a free consultation and we’ll go through your options together.
Frequently Asked Questions
Does Medicare cover prescription drugs?
Not through Original Medicare alone. Prescription drug coverage comes through Medicare Part D, either as a standalone Prescription Drug Plan or bundled into a Medicare Advantage plan.
What does Medicare Part D cover?
Part D covers self-administered outpatient prescription drugs and certain vaccines, like the shingles and Tdap vaccines. Exactly which drugs are covered, and at what cost, depends on your plan’s formulary.
What is a Medicare Part D formulary?
A formulary is your plan’s official list of covered drugs, organized into cost tiers. Formularies vary by plan and can change from year to year, which is why it’s worth checking yours during Annual Enrollment.
Does the Medicare Part D coverage gap, or “donut hole,” still exist?
No. The coverage gap was eliminated starting in 2025 and remains gone in 2026, replaced by a simplified three-phase cost structure with a $2,100 annual out-of-pocket cap.
How much does Medicare Part D cost in 2026?
Costs depend on your plan and phase: up to a $615 deductible, then copays or coinsurance by formulary tier, until you reach the $2,100 out-of-pocket cap, after which covered drugs cost $0 for the rest of the year.
The Bottom Line
Medicare Part D comes down to one key point: Original Medicare doesn’t cover your prescriptions on its own, and the plan you choose to fill that gap matters as much as whether you have coverage at all. With the donut hole gone and a $2,100 out-of-pocket cap in place for 2026, the cost structure is simpler than it used to be, but choosing the right plan for your specific medications still takes a real comparison, not a guess.
Bring your medication list, and we’ll find the plan that covers them for less. Call 918-815-6382 or schedule a free consultation and we’ll walk through your options before Annual Enrollment closes. You can also browse our Medicare plan options or read our Medicare frequently asked questions for more detail.