Medicare Part D in Texas: What Changed and What It Costs

The out-of-pocket cap is the headline

For 2026, what you pay out of pocket for covered drugs under Part D is capped at $2,100, up from $2,000 in 2025. Once you reach it, covered prescriptions cost you nothing for the rest of the year.

Before this change there was no ceiling at all, and people on expensive specialty drugs could spend many thousands annually with no end point. For anyone in Texas taking a high-cost medication, this is the most consequential Medicare change in years.

The donut hole is gone

The old coverage gap, universally known as the donut hole, was permanently eliminated in 2025. Part D now has a simpler structure: a deductible phase if your plan has one, an initial coverage phase, and then catastrophic coverage with no cost sharing once you hit the cap.

The maximum deductible a Part D plan may charge in 2026 is $615. Many plans set theirs lower, and some waive it entirely for generic drugs, so the deductible is worth comparing rather than assuming.

Formularies matter more than premiums

Every Part D plan publishes a formulary listing which drugs it covers and on which tier. The same medication can sit on tier 2 with one plan and tier 4 with another, and that difference usually dwarfs any difference in monthly premium.

If you take brand-name or specialty medications, comparing formularies is the single highest-value thing you can do during enrollment. A plan that looks $15 a month cheaper can easily cost you several hundred more across the year.

Do not skip Part D because you take nothing now

The Part D late enrollment penalty is 1% of the national base premium for every month you went without creditable drug coverage, and like the Part B penalty it is permanent.

Going without Part D for five years because you take no prescriptions means a 60% surcharge for the rest of your life once you do need it. A minimal plan is usually far cheaper than the penalty for skipping one.

Pharmacy networks matter in Texas

Part D plans have preferred pharmacy networks, and the same drug at the same plan can cost noticeably less at a preferred pharmacy than a standard one. In Harris, Dallas, Bexar and Tarrant counties you will usually have several preferred options within a short drive. In the rural counties of West Texas and the Panhandle, the nearest preferred pharmacy may be considerably further, which is worth checking before enrolling.

Mail order is the usual answer where local preferred pharmacies are scarce, and for maintenance medications it is often cheaper regardless of geography. If you take a drug that requires refrigeration or frequent adjustment, confirm mail order actually suits it before relying on it.

Part D questions worth asking

What if my drug is not on the formulary? You can request a formulary exception with your prescriber's support, or ask about a covered therapeutic alternative. Neither is automatic, so start before you run out.

What is prior authorization? Some drugs require the plan's approval before it will cover them. It is common for expensive and specialty medications and is worth knowing about in advance rather than at the pharmacy counter.

Can I change plans if my drugs change? Generally only during the fall enrollment window, unless you qualify for a Special Enrollment Period. That is why an annual formulary check matters.