Medicare Part D in Texas: 2026 Key Numbers
| Out-of-Pocket Maximum (2026) | $2,100/year |
|---|---|
| Maximum Part D Deductible | $615/year |
| National Base Beneficiary Premium | $38.99/month |
| Coverage Gap (“Donut Hole”) | Eliminated as of 2025 |
| Standalone Part D Plans in Texas | 28 |
| Late Enrollment Penalty | 1% × $38.99 per month uncovered |
How Medicare Part D Works in Texas
Medicare Part D provides prescription drug coverage for Medicare beneficiaries in Texas. In 2026, the most significant change to Part D is the $2,100 annual out-of-pocket cap — the first hard cap in Part D’s history, established by the Inflation Reduction Act. Once you spend $2,100 on covered drugs in a calendar year, your Part D plan pays 100% for the rest of the year. This protects Texas beneficiaries with high drug costs from catastrophic prescription expenses.
2026 Part D Out-of-Pocket Cost Scenarios for Texas Residents
| Annual Drug Cost | Your Estimated OOP (2026) | Plan Pays | Notes |
|---|---|---|---|
| $1,200/year (low) | ~$615 (deductible) + 25% coinsurance = ~$765 | 75% after deductible | Below catastrophic threshold |
| $4,800/year (moderate) | ~$1,200–$1,800 | 75% after deductible | Well below $2,100 cap |
| $12,000/year (high) | Capped at $2,100 | 100% after cap | Cap protects high-cost patients |
| $50,000/year (specialty drugs) | Capped at $2,100 | 100% after cap | Critical protection for cancer, MS, etc. |
Part D Late Enrollment Penalty in Texas
If you go without creditable prescription drug coverage for 63 or more consecutive days after becoming eligible for Medicare Part D, you will pay a late enrollment penalty for as long as you have Part D coverage. The penalty is calculated as 1% of the national base beneficiary premium ($38.99/month in 2026) for each month you were without coverage. For example, if you went 24 months without Part D coverage, your penalty would be 24% × $38.99 = $9.36/month added to your premium permanently.
Late Enrollment Penalty Calculator for Texas
| Months Without Coverage | Monthly Penalty (2026) | Annual Extra Cost |
|---|---|---|
| 12 months | $4.68/month | $56.15/year |
| 24 months | $9.36/month | $112.29/year |
| 36 months | $14.04/month | $168.44/year |
| 60 months | $23.39/month | $280.73/year |
Extra Help (Low Income Subsidy) for Texas Residents
Low-income Medicare beneficiaries in Texas may qualify for Extra Help, which reduces Part D costs to nominal copays ($4.90 for generics, $12.15 for brand-name drugs in 2026) and eliminates the late enrollment penalty. To qualify for full Extra Help in Texas, your monthly income must be at or below $1,255 (individual) or $1,704 (couple). Apply through Social Security at ssa.gov or call 1-800-772-1213.
Choosing a Part D Plan in Texas
Texas has 28 standalone Part D plans available. The most important factor in choosing a plan is whether your specific medications are on the plan’s formulary at a reasonable tier. Use the Medicare Plan Finder at medicare.gov/plan-compare to enter your exact medications and compare total annual costs — premium plus deductible plus copays — across all 28 plans. The plan with the lowest premium is rarely the lowest total cost if your drugs are on a high tier.
Part D and Medicare Advantage in Texas
Most Medicare Advantage plans in Texas include prescription drug coverage (MAPD plans). If you enroll in a Medicare Advantage plan with drug coverage, you cannot also have a standalone Part D plan. The 118 Medicare Advantage plans in Texas include both MAPD (with drug coverage) and MA-only (without drug coverage) options. If you choose an MA-only plan, you can add a standalone Part D plan.
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