Prescription Coverage

Changes to your Medicare prescription (Part D) benefit for 2026

Here are some changes to your individual Medicare Advantage prescription benefit beginning January 1, 2026:

• The donut hole or coverage gap phase was eliminated.
• The annual out of pocket maximum is $2,100 (in 2025 it was $2,000).
• The Medicare Prescription Payment Plan (commonly referred to as M3P) allows you to pay for your prescriptions in monthly payments to HAP over time instead of at the pharmacy counter.
• There are drug coverage changes including tiering, copay and deductible changes.

Want to know more?

Check out this video featuring Natalie Pirokla, PharmD, HAP's vice president of clinical strategy & population health, where she explains the Medicare prescription (Part D) benefit details for 2026.

Prescription drug stages

For 2026, the Medicare Part D structure consists of three stages:

Stage 1 - If your plan has a deductible, you need to pay that deductible to enter the next stage of coverage.

Stage 2 - This coverage stage occurs after the deductible is met. You will have a copay or coinsurance until your $2,100 out-of-pocket maximum is reached. This stage is where you will spend the majority of your prescription drug costs, and it covers both generic and brand-name drugs.

Stage 3 – You’ve reached $2,100 in out-of-pocket costs, including your payments and those of others who pay on your behalf. This stage is called the catastrophic phase of coverage. You will pay nothing for covered drugs for the remainder of the coverage year. 

Tools to help you find and compare prescription drugs covered by Medicare and benefits

We make every effort to ensure you receive safe, appropriate drugs. We have Medication Therapy Management and Utilization Management programs in place to identify potential problems and resolve them before they become an issue.

Find out if your Medicare plan covers your prescription drug

We also have a tool to make comparing drug plans easier. If you're concerned about how to pay for your prescription drugs, we may be able to help with that, too.

Compare prescription drug benefits and costs

If your medication is covered by your Medicare insurance, you can use our online tool, Express Scripts, to compare prescription drug benefits across different plans. You can also compare plan options against current medication costs to choose the plan that best meets your needs. To use Express Scripts and see if your medication is covered, select your plan below:

Medicare Advantage Plans 2026

• HAP Medicare Connect (HMO)
• Henry Ford Select (HMO)
• HAP Medicare Superior (HMO)
• HAP Medicare MedicalAccess (HMO)
• HAP Senior Plus Henry Ford Tiered Access (HMO)
• HAP Senior Plus (HMO-POS)
• HAP Member Assist (PPO)
• HAP Medicare Prime (PPO)
• HAP Medicare Explore (PPO)
• HAP Senior Plus (PPO)
• HAP Medicare Complete Duals (HMO D-SNP)
• HAP Medicare Complete Assist (PPO D-SNP)
• HAP Medicare Diabetes and Heart (HMO C-SNP)

After selecting your plan above, select a plan year and plan. The tool does the rest. You'll be able to compare annual costs across plans, check medication prices, see what pharmacies are in-network and find out what medications are covered.

Get help paying for prescriptions

If you have limited income, you may qualify for extra help with prescription drug coverage costs through the Medicare Part D subsidy. If you qualify and enroll in one of our Medicare Advantage plans with prescription drug coverage, you may pay less for copays and premiums.

Learn more

Fill a prescription

Members can get brand-name and generic prescription drugs at any of the 2,000 pharmacies in our network.

Learn more