What Is the Medicare Part D Deductible (and Why You Might Not Pay It)

Created by Melinda Caughill, Modified on Mon, 29 Dec, 2025 at 3:37 PM by Melinda Caughill

HeyMOE Tip:
When you see a “$600 deductible” on your plan, don’t panic — look at which drug classification tiers it applies to (see below). HeyMOE automatically factors this in when calculating your personalized savings and plan recommendations.

Understanding the Part D Deductible

Every Medicare Part D drug plan includes something called a deductible — the amount you may have to pay out of pocket before your plan starts covering your prescriptions.

For 2026, the maximum deductible any plan can charge is $615 . However, not everyone actually pays that amount — and here’s why.

The Deductible Doesn’t Always Apply to Every Drug

Most Medicare drug plans organize medications into tiers — basically, pricing levels based on how expensive a medication is and whether it’s generic or brand-name.

Here’s a quick breakdown:

Tier	Typical Drug Type	What You Pay	Deductible Applies?
Tier 1	Preferred generics	$0–$5 copay	Usually No
Tier 2	Non-preferred generics	$5–$10 copay	Sometimes
Tier 3	Preferred brand-name	$30–$50 copay	Yes
Tier 4+	Non-preferred / specialty	$$$	Yes

So even if your plan lists a $600+ deductible, it may only apply to higher-tier (brand-name or specialty) medications.

That means if you take only Tier 1 or Tier 2 generics — as most people do — you could start the year paying $0 or very low copays, even though your plan technically includes a deductible.

Real-World Example

Let’s say your Part D plan has a $615 deductible and covers your two medications like this:

Lisinopril (generic for blood pressure) → Tier 1 → $0 copay
Simvastatin (generic for cholesterol) → Tier 1 → $0 copay

Because both drugs are Tier 1, your deductible doesn’t apply — you’ll never actually “hit” your $615 deductible unless you add a higher-tier medication later.

Why This Matters

Many people see a high deductible and assume they’ll have to pay hundreds out of pocket before their coverage starts. But that’s often not the case.

Your deductible may look scary on paper, but depending on your medications, you may never pay a dime toward it.

That’s one of the many reasons HeyMOE reviews your plan each year — to make sure you’re not overpaying for a plan with a deductible that doesn’t even affect your prescriptions.

In Short

Every Medicare Part D plan has a deductible, but it often applies only to higher-tier drugs.
Most common generics (Tier 1 and Tier 2) bypass the deductible entirely.
You could have a $615 deductible and still pay $0 for your everyday medications.