Shields Up Provides Important Information on 2026 Medicare Part D: What Employers Need to Know

What is Medicare Part D? Medicare Part D helps individuals with Medicare pay for prescription drugs. Each year, the government updates the rules, and these updates can affect employers who provide prescription drug coverage to Medicare-eligible employees or retirees.

What's Changing?

• Out-of-pocket cap rises to $2,100 (up from $2,000). 
• Medicare now pays 10% of costs for certain high-priced drugs early in the year.
• Creditable coverage must cover at least 72% of expected drug costs (up from 60% in 2025).
• Plans can switch mid-year to generics or biosimilars when available.

• You may need to update your prescription coverage to meet Medicare's new standards.
• Be sure to notify Medicare-eligible employees or retirees about whether your plan qualifies as creditable coverage - send by Oct. 15th.
• Start preparing now to stay compliant and avoid penalties.

• Educate Medicare-eligible employees on upcoming Medicare Part D changes and what they mean for their current coverage.
• Provide one-on-one reviews to compare their existing group coverage with available individual Medicare options.
• Guide the transition for Medicare-eligible employees and retirees from group coverage to an individual Medicare plan that fits their healthcare and financial needs.
• Offer year-round service and support to employees, retirees, and their spouse.