What You Need to Know About Medicare Extra Help and Part D Costs in 2026
Medicare has announced important changes to prescription drug coverage costs for 2026. Here's what Pennsylvania residents need to know.
Key Changes at a Glance
Good news: Pennsylvania's Regional Benchmark (the average monthly premium for basic prescription drug coverage within a given region) dropped significantly—from $48.06 in 2025 to $32.71 in 2026. If you get Extra Help, the premium for a basic stand-alone Part D plan is fully covered if you enroll in a plan at or below the Benchmark. For those in a Medicare Advantage plan, the Part D portion of the Medicare Advantage plan premium can be reduced up to the benchmark amount.
What's increasing: The national base beneficiary premium rose 6% to $38.99. If you're paying a late enrollment penalty, you'll see this reflected in your costs.
If You Don't Qualify for Extra Help
The standard* Part D plan in 2026 will include:
- Monthly premium: Varies depending on which plan you choose
- Annual deductible: $615
- Your costs after the deductible: You'll pay 25% of the cost for each covered prescription until your total drug spending reaches $2,100
- Catastrophic coverage: Once you reach the catastrophic phase, covered prescriptions cost $0
* NOTE: Standard plans follow Medicare’s basic coverage rules, though actual plan details may vary.
If You Qualify for Extra Help
Extra Help (also called the 'Low-Income Subsidy' or LIS) significantly reduces prescription costs for those who qualify. If you qualify for Extra Hel inb 2026, you'll pay:
- Monthly premium: $0 if you enroll in one of Pennsylvania's benchmark plans (listed below)
- Prescription copays: Your copay depends on your situation:
- $0 if you receive long-term care services through Medicaid (nursing home or home and community-based services/HCBS)
- $1.60 for generics / $4.90 for brand-name drugs if you have full Medicaid and income below 100% of the Federal Poverty Level
- $5.10 for generics / $12.65 for brand-name drugs for all other Extra Help recipients
Learn more about qualifying for Extra Help by downloading our 2025 Extra Help Fact Sheet (available in English and Spanish). This fact sheet will be updated with 2026 Extra Help information early next year.
Zero Premium Medicare Part D Plans in 2026
If you qualify for Extra Help or are dual eligible (have both Medicare and Medicaid), the three (3) benchmark plans listed in the table below have no monthly premium in 2026:
Get Free Help Choosing a Plan
Not sure which plan is best for you? Pennsylvania Medicare Education and Decision Insight (PA MEDI) provides free, confidential, unbiased counseling to help you review your Medicare coverage options for 2026. You can contact PA MEDI at 1-800-783-7067 or click here to check for events in your area.
