Medicare Part D True Out-of-Pocket (TrOOP) Calculator
Estimate your Medicare Part D out-of-pocket drug costs for 2026. The donut hole is gone, and a $2,100 yearly cap now limits what you pay.
The Medicare Part D donut hole ended in 2025. In its place is a yearly cap on out-of-pocket costs, $2,100 for 2026. After you reach it, covered prescriptions cost $0 for the rest of the year. This calculator estimates what you will pay from your expected drug costs. For 2027 the cap rises to $2,400 and the maximum deductible to $700.
Since January 1, 2025, Part D has had three stages: a deductible, a stage where you pay part of the cost, and a stage where you pay nothing. Enter your estimated drug costs for the year to see what you would 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. However high your total drug costs are, your out-of-pocket spending on covered drugs cannot go above 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 25% coinsurance throughout the initial coverage stage. Most plans charge flat copays that differ by drug tier, so your costs may be higher or lower than this estimate. Use Medicare's Plan Finder for figures based on your own drugs and plan.
| Stage | What you pay in 2026 | It ends when |
|---|---|---|
| Deductible | The full price of your drugs | You have paid your plan's deductible, at most $615. Many plans set it lower or have none. |
| Initial coverage | 25% of the cost under the standard design. Most plans use copays by tier. | Your out-of-pocket costs for the year reach $2,100 |
| Catastrophic | $0 for covered drugs | December 31 |
Two examples, standard design.
- Drugs costing $3,000 for the year: $615 deductible, plus 25% of the remaining $2,385, which is $596. Total about $1,211.
- Drugs costing $8,000 for the year: $615, plus 25% of $7,385, would be $2,461. The cap stops it at $2,100.
What counts toward the cap. What you pay for covered drugs: the deductible, copays and coinsurance. Premiums do not count, and neither do drugs your plan does not cover, so check that each of your drugs is on the formulary.
If the cost comes early in the year. Someone on an expensive drug can reach the cap within a few months. The Medicare Prescription Payment Plan lets you spread those costs over monthly bills. It does not change the total.
If the total is hard to afford. Check Extra Help, which lowers the deductible and copays for people with limited income.
Frequently Asked Questions
Does the Medicare Part D donut hole still exist?
No. The donut hole, also called the coverage gap, ended on January 1, 2025. Part D now has a deductible stage, an initial coverage stage and a catastrophic stage, with a cap on what you pay.
What is the Medicare Part D out-of-pocket cap for 2026?
$2,100. After your out-of-pocket spending on covered drugs reaches that amount, you pay $0 for covered medications for the rest of the calendar year.
What is the Medicare Part D deductible for 2026?
Up to $615. That is the most a plan can charge before coverage begins. Some plans charge less or have no deductible.
How much coinsurance do I pay for Part D drugs?
Under the standard design, 25% during the initial coverage stage, after the deductible, until your out-of-pocket spending reaches the $2,100 cap. Many plans use flat copays by tier instead.
Will I definitely reach catastrophic coverage?
Only if your drug costs are high enough. Many people with lower costs stay in the initial coverage stage all year.
Does the Medicare Prescription Payment Plan (M3P) change how much I pay?
No. Your total for the year is the same. The plan spreads your out-of-pocket Part D costs into monthly payments, so you do not pay as much at the pharmacy early in the year.
This calculator gives a simplified estimate based on the 2026 Medicare Part D standard benefit. It is not financial or insurance advice. It assumes a flat 25% coinsurance and does not account for a plan's copay tiers or for Extra Help, which can change your costs. For your plan's costs, check your Explanation of Benefits or contact your Part D plan.