Medicare Part D is Medicare’s prescription drug coverage. It is optional, it is sold by private insurance companies approved by Medicare, and anyone with Medicare Part A or Part B can join if they live in the plan’s service area. In New York, a state program called EPIC adds a second layer of help for residents 65 and older with incomes below $75,000 (single) or $100,000 (married).
What is Medicare Part D?
According to Medicare.gov, Part D (which it calls Medicare drug coverage) helps pay for brand-name and generic prescription drugs. You get it in one of two ways:
- A separate drug plan that adds drug coverage to Original Medicare (Part A and Part B).
- A Medicare Advantage plan that includes drug coverage. These bundled plans combine hospital, medical and usually drug coverage.
Each plan has its own list of covered drugs, called a formulary, and its own costs. If a drug is not on the list, the prescriber can ask the plan for an exception. Part B, separately, covers a limited set of outpatient drugs, usually ones given in a doctor’s office.
This page is general information, not insurance advice, and we do not recommend plans. To keep track of the medicines themselves, see our medication management guide. For how Medicare and Medicaid fit together, see Medicare versus Medicaid in New York.
Who is eligible for Medicare Part D?
To join a Medicare drug plan you generally need all of the following, per Medicare.gov’s joining a plan page:
- Medicare Part A and/or Part B (for a Medicare Advantage plan with drug coverage you need both).
- To be a U.S. citizen or national, a lawful permanent resident, a Cuban-Haitian entrant, or lawfully living in the U.S. as a Compact of Free Association migrant.
- A home address inside the plan’s service area.
You do not need to take prescriptions today. Medicare.gov suggests getting a plan anyway, because waiting can mean a permanent late penalty (see below).
How do you sign up for Medicare Part D?
You can only join, switch or drop a drug plan during certain enrollment periods. These steps follow Medicare.gov.
- Gather your details. You need your Medicare Number and your Part A and/or Part B start dates, both printed on the Medicare card.
- Find plans in your area. Use the Medicare Plan Finder, adding every prescription you take, and check that your pharmacy is in the network.
- Review the costs. Look at the premium, deductible and estimated yearly drug cost together.
- Join. Choose “Enroll” on the Plan Finder, contact the plan (a paper form must reach it before your enrollment period ends), or call 1-800-MEDICARE at 1-800-633-4227 (TTY 1-877-486-2048).
- Check your start date. It depends on which enrollment period you used.
| Enrollment period | When | What you can do |
|---|---|---|
| Initial Enrollment Period | 7 months around turning 65: 3 months before the month you turn 65 through 3 months after | Join any plan. You need Part A or Part B to join a drug plan |
| Open Enrollment Period | October 15 to December 7 | Join, drop or switch drug plans, or switch between Original Medicare and Medicare Advantage. Coverage starts January 1; the plan must get your request by December 7 |
| Medicare Advantage Open Enrollment | January 1 to March 31, only if you are already in a Medicare Advantage plan | Switch to another Medicare Advantage plan, or return to Original Medicare and join a separate drug plan |
| Special Enrollment Period | Varies, tied to a life event | Examples listed by Medicare.gov: moving, losing or changing coverage, getting Medicaid, or getting Extra Help |
What is the Part D late enrollment penalty?
It is an amount added to your monthly premium, and it is not a one-time fee. Medicare.gov says you generally pay it for as long as you have drug coverage if, after your Initial Enrollment Period ends, you go 63 days or more in a row without Part D or other creditable drug coverage (coverage similar in value to Part D).
The penalty is 1% of the national base beneficiary premium ($38.99 in 2026) for each full month you were eligible but uncovered, rounded to the nearest 10 cents. Medicare.gov’s example: waiting 14 months means a 14% penalty, or $5.50 a month in 2026, on top of the premium. You do not pay it while you receive Extra Help.
How much does Part D cost in 2026?
Premiums vary by plan and can be higher with higher income. These are the figures on Medicare.gov’s Part D costs page, checked in October 2026:
| Stage | 2026 | 2027 |
|---|---|---|
| Deductible (the most any plan may charge; some plans have none) | $615 | $700 |
| Initial coverage: you pay 25% of the cost of covered drugs until out-of-pocket spending reaches | $2,100 | $2,400 |
| Catastrophic coverage: after that point | $0 for covered Part D drugs for the rest of the calendar year | $0 for covered Part D drugs for the rest of the calendar year |
The limit counts certain payments made on your behalf, including through Extra Help, and per Medicare.gov may also count State Pharmaceutical Assistance Program contributions, the category EPIC falls into.
The Medicare Prescription Payment Plan
Every plan offers this voluntary option: instead of paying at the pharmacy, you get a monthly plan bill that spreads your out-of-pocket drug costs across the year, at no charge. Medicare.gov is clear that it does not lower what you owe, and it may be a poor fit if your costs are low or steady, you sign up after September, or you already get Extra Help. Call your plan to start.
What is Extra Help, and who qualifies in 2026?
Extra Help is a Medicare program that helps people with limited income and resources pay Part D premiums, deductibles and coinsurance. Medicare.gov lists these 2026 limits:
| Your situation | Income limit | Resource limit |
|---|---|---|
| Individual | $23,940 | $18,090 |
| Married couple | $32,460 | $36,100 |
You get Extra Help automatically if you have full-benefit Medicaid, get help paying your Part B premium through a Medicare Savings Program, or receive Supplemental Security Income. Everyone else can apply through Social Security (Medicare.gov links to ssa.gov/medicare/part-d-extra-help) or ask a counselor for help. The same application can also start a Medicare Savings Program application.
For 2027, Medicare.gov lists no plan deductible, up to $5.80 per generic and $14.40 per brand-name drug, and $0 once total drug costs reach $2,400. It did not list 2026 copays, so confirm those with your plan.
What is EPIC, New York’s drug program for seniors?
EPIC (Elderly Pharmaceutical Insurance Coverage) is a New York State program run by the Department of Health. Per the Department’s EPIC page, it helps income-eligible seniors 65 and older with out-of-pocket Part D costs, and they can apply at any time of the year. EPIC does not replace Part D: you must be enrolled in or eligible for a Part D plan.
Who can join EPIC?
The Department’s eligibility page lists four requirements:
- A New York State resident aged 65 or older.
- Annual income below $75,000 if single or $100,000 if married, counted from the previous year.
- Enrolled or eligible to enroll in a Medicare Part D plan, with no exceptions. A Medicare Advantage HMO member qualifies only with drug coverage through that plan.
- Not receiving full Medicaid benefits.
No documents are needed to apply, since EPIC checks income with the Social Security Administration and the state tax department. Joining EPIC also gives a new member a Special Enrollment Period to join a Part D plan.
How does EPIC work with Part D?
At the pharmacy you show both cards. Part D pays first. After any Part D deductible is met, the costs the plan leaves, including copays and coinsurance, can go to EPIC, and you pay an EPIC copay of $3, $7, $15 or $20 depending on the drug’s cost. EPIC also covers approved drugs Part D excludes, such as prescription vitamins.
EPIC has two plans, based on the previous year’s income. Here are the 2026 figures from the Department’s 2026 program highlights:
| Fee Plan | Deductible Plan | |
|---|---|---|
| Income, single | Up to $20,000 | $20,001 to $75,000 |
| Income, married | Up to $26,000 | $26,001 to $100,000 |
| What you pay to belong | Annual fee of $8 to $300, billed quarterly if you choose | No fee, but an annual deductible of $530 to $3,215 before EPIC copays begin |
| Part D premium help | EPIC pays the premium up to $58.82 a month in 2026 | Same, for incomes up to $23,000 single or $29,000 married; above that, members pay it and the deductible is lowered by about $706 |
Members approved for Extra Help, a Medicare Savings Program or Medicaid spend-down do not pay EPIC fees, and income-eligible members are required to apply for Extra Help. These figures are for plan year 2026; EPIC publishes a new schedule each year, so confirm the 2027 numbers. If your Part D premium is higher than $58.82, you pay the difference.
How do you apply for EPIC?
- Get the application. Apply online or download the form from the EPIC application page.
- Send it in. Mail it to EPIC, P.O. Box 15018, Albany, NY 12212-5018, or fax it to (518) 452-3576.
- Call with questions. The EPIC Helpline, 1-800-332-3742 (TTY 1-800-290-9138), is open 8 a.m. to 5 p.m., Monday to Friday.
How do people with Medicaid get their prescription drugs?
A person with both Medicare and full-benefit Medicaid gets Extra Help automatically, per Medicare.gov. Medicare enrolls them in a Part D plan if they do not already have one, and mails a notice about the plan and what they will pay. They can pick a different plan, and people with Medicaid or Extra Help may be able to change drug coverage once a month.
Medicare’s LI NET program (1-800-783-1307) gives temporary Part D coverage to people who qualify but are not yet in a plan. A full-Medicaid member cannot join EPIC, but Medicaid spend-down and Medicare Savings Program members can. See Medicaid spend-down in New York.
Does Part D cover shingles and RSV vaccines?
Yes. Medicare.gov says Part D covers all adult vaccines recommended by the CDC’s Advisory Committee on Immunization Practices that are not covered under Part B, including the shingles and RSV vaccines. Plans cannot charge a copayment or apply a deductible for them. Flu, COVID-19 and pneumonia shots fall under Part B. For which shots are advised this season, see our senior vaccine guide.
How do you compare plans and find free help?
Start with the Plan Finder, entering your drugs and pharmacy, then confirm details with the plan. Plans can change their drug lists during the year and must tell you about changes that affect your drugs. Free help is available:
- HIICAP, New York’s State Health Insurance Assistance Program, at 1-800-701-0501. Per Medicare.gov, these programs give free local counseling and are not connected to any insurance company. See shiphelp.org.
- 1-800-MEDICARE (1-800-633-4227), for plan and benefit questions.
- The EPIC Helpline (1-800-332-3742), for questions about the state program.
Finding out what you qualify for: advice from our nurse director
Anna Klyauzova, RN, MSN, MPA, Director of Patient Services at ProLife Home Care, on what she sees in practice:
Families often haven’t heard of the Medicare Savings Programs, Extra Help with prescription costs, SNAP, or HEAP for heating bills. Many never check Medicaid or home care eligibility because they assume their income is too high.
If you don’t know what you qualify for, start with what is on the table: insurance, income, benefits already received and the person’s care needs. You don’t have to fill out a dozen applications this week. First find out which programs fit. NYC Aging, NY Connects and Medicaid specialists are good places to ask, and hospital Medical Social Services can help in tricky situations. We help families understand their home care options in Brooklyn and Queens and send them to the right specialist for the rest, so nobody has to sort it out alone. See also our financial help guide for seniors in NYC.
We are a licensed home care agency in Brooklyn and Queens, licence #2572L001, New York State Department of Health. We do not enroll people in drug plans or sell insurance, so use the free counseling above for plan questions. For care at home, call (718) 232-2777 or use our contact page.
Medicare and EPIC figures change every year. Everything above was checked on 14 October 2026 against medicare.gov, health.ny.gov (EPIC) and shiphelp.org; EPIC figures are for plan year 2026. Confirm your own situation with your plan, HIICAP or 1-800-MEDICARE. This is general information, not insurance advice, and it recommends no plan.
Frequently asked questions
What is Medicare Part D?
It is Medicare’s optional prescription drug coverage, offered by private insurance companies approved by Medicare. You get it as a stand-alone drug plan added to Original Medicare or inside a Medicare Advantage plan that includes drugs.
Who is eligible for Medicare Part D?
Anyone with Medicare Part A and/or Part B who lives in the plan’s service area and is a U.S. citizen or national, lawful permanent resident, Cuban-Haitian entrant or Compact of Free Association migrant. You do not need to take prescriptions to join.
How do I sign up for Medicare Part D?
Compare plans on Medicare.gov/plan-compare, then enroll there, contact the plan, or call 1-800-MEDICARE. You can usually enroll when you first get Medicare, between October 15 and December 7 each year, or during a Special Enrollment Period.
Is Part D mandatory, and what happens if I wait?
It is optional, but if you go 63 days or more without Part D or creditable drug coverage after your Initial Enrollment Period, you generally owe a late enrollment penalty. It is 1% of $38.99 (the 2026 base premium) for each uncovered month, added to your premium for as long as you have coverage.
Is there a cap on what I pay for drugs in 2026?
Yes. Medicare.gov says out-of-pocket spending on covered Part D drugs is capped at $2,100 in 2026 ($2,400 in 2027). After you reach it, you pay nothing for covered Part D drugs for the rest of the year.
Can I have both EPIC and Part D?
Yes, and you must. EPIC pays after Part D, so you need a Part D plan to receive EPIC benefits. You must be a New York resident aged 65 or older with income below $75,000 (single) or $100,000 (married), and not on full Medicaid.
Does Part D pay for the shingles vaccine?
Yes. Medicare.gov says Part D covers the shingles and RSV vaccines with no copayment or deductible, as part of the adult vaccines the CDC advisory committee recommends. Ask your plan or pharmacy how to get them.
