What Part D covers
Medicare Part D helps pay for prescription drugs you take at home. Private insurance companies approved by Medicare run the plans. Each plan has a formulary, its list of covered drugs, sorted into tiers that set what you pay. Recommended adult vaccines, such as shingles, are covered at no cost to you.
There are two ways to get Part D in Texas:
- A standalone drug plan (PDP) — added to Original Medicare, often with a Medigap policy.
- A Medicare Advantage plan with drug coverage (MA-PD) — one plan for hospital, medical and drug coverage. See Medicare Advantage in Texas.
Texas's 2027 standalone drug plans
Texas is a single Part D region, so the same standalone plans are sold in all 254 counties. Here is what CMS lists for 2027:
| Plan year 2027 | Texas |
|---|---|
| Standalone drug plans sold in Texas | 10 |
| Companies offering them | 5 |
| Standard yearly deductible | $700 |
| Yearly out-of-pocket cap on covered drugs (2027) | $2,400 |
The lowest premium isn't always the lowest total cost. What you pay depends on whether your drugs are on the plan's formulary, their tier, the deductible, and whether your pharmacy is in the plan's network.
Drug coverage through Medicare Advantage
Medicare Advantage plans can include drug coverage, but what's sold depends on your county. For 2027, the number of Medicare Advantage plans with drug coverage open to everyone ranges from 41 in Harris County to 3 in Brewster County. Where few are sold, a standalone drug plan may be how you get Part D, unless you qualify for a special needs plan. See your county's plans.
2026 Part D costs
| Cost | 2026 |
|---|---|
| Yearly out-of-pocket cap on covered drugs | $2,100 |
| Highest deductible a plan can charge | $615 |
| Covered insulin, per month's supply | $35 at most |
| National base beneficiary premium (used for the late penalty) | $38.99 |
Once your out-of-pocket spending on covered drugs reaches the cap, you pay nothing more for covered drugs for the rest of the year. The old coverage gap ("donut hole") ended in 2025. You can also ask your plan to spread your drug costs over the year with the Medicare Prescription Payment Plan, which Part D plans must offer.
Extra Help with drug costs
Extra Help is a Medicare program that lowers Part D premiums, deductibles and copays for people with limited income and resources. In 2026 you may qualify if your yearly income is below about $23,940 ($32,460 for a married couple) and your resources are below $16,590 ($33,100 for a couple). With full Extra Help, generic drugs cost no more than $5.10 and brand-name drugs no more than $12.65 in 2026.
People with Texas Medicaid or a Medicare Savings Program get Extra Help automatically. Others can apply with Social Security or call 1-800-772-1213. See Medicare Savings Programs and Extra Help in Texas.
The late enrollment penalty
If you go 63 days or more in a row without Part D or other creditable drug coverage after you first become eligible, you may owe a penalty for as long as you have Part D. It's 1% of the national base beneficiary premium ($38.99 in 2026) for each full month you went without coverage. For example, 24 months without coverage adds about $9.36 a month in 2026. Coverage from an employer, union, TRICARE or the VA usually counts as creditable: see working past 65.
How to choose a plan
- List your drugs and doses, and the pharmacies you use.
- Check each plan's formulary for your drugs and their tiers, and whether your pharmacy is in network.
- Compare the total yearly cost — premium, deductible and copays together — not just the premium.
- Get help comparing. Use Medicare's Plan Finder, or talk with a licensed insurance agent at no cost to you.
You can join or switch plans during Open Enrollment, October 15 to December 7, for coverage starting January 1.
See Medicare plans in your area
Enter your ZIP code to compare Medicare Advantage, Part D, and Medigap plans available where you live.
You'll go to PlanMatchMedicare.com, a plan comparison site from Benefits Life, the publisher of this site. Only your ZIP code is sent.
Frequently asked questions
How many Part D plans are there in Texas for 2027?
CMS lists 10 standalone Part D plans from 5 companies, sold in every Texas county. Medicare Advantage plans can also include drug coverage, depending on your county.
What is the most I'll pay for drugs?
Out-of-pocket spending on covered Part D drugs is capped at $2,100 in 2026 and $2,400 in 2027. After that, you pay nothing more for covered drugs that year. Premiums are separate.
Do I need Part D if I don't take any drugs?
If you have no other creditable drug coverage, joining when you're first eligible avoids a lifelong late enrollment penalty, even if you take no drugs now. A low-premium plan keeps the cost down.
How do I get help paying for prescriptions?
Extra Help lowers Part D costs for people with limited income and resources; apply through Social Security at 1-800-772-1213. People with Texas Medicaid get it automatically.
Sources
Plan counts, premiums, deductibles, star ratings and the 2027 out-of-pocket cap are from CMS's 2027 Landscape file for Texas; Medicare Advantage drug coverage by county is from the same file. Program amounts are CMS's 2026 figures.
