Medicare Part D
Medicare Part D's 2027 Cap in Antioch, Calif.
Antioch, Calif. — Starting Jan. 1, 2027, the hard annual cap on what you pay out of pocket for covered Part D prescription drugs rises to $2,400, up from $2,100 in 2026. For people in Antioch who have watched their pharmacy bills creep up, that ceiling is the headline number to know this Annual Enrollment Period, which runs Oct. 15 through Dec. 7.
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Click to call 855-729-3240Key takeaways
- Starting Jan. 1, 2027, most people with Medicare Part D drug coverage will pay nothing for covered prescriptions once their out-of-pocket costs reach the annual cap, which is $2,100 in 2026 and $2,400 in 2027.
- The yearly Part D deductible can be no higher than $615 in 2026 and $700 in 2027, and the old "donut hole" coverage gap was already eliminated in 2025.
- The optional, free Medicare Prescription Payment Plan lets you spread your drug costs into monthly payments instead of paying large amounts at the pharmacy, though it doesn't lower drug prices.
- The Annual Enrollment Period runs Oct. 15 through Dec. 7, and reviewing your plan's drug list, pharmacy network, and IRMAA income thresholds each year can help you understand your costs, even though the out-of-pocket cap and deductible limit apply to every plan.
Here's a plain-language look at what's changing, how the new payment plan works, and where to get local help.
The 2027 cap, in plain English
Under the rule, once your out-of-pocket spending on covered Part D drugs hits the annual cap, you pay nothing for covered prescriptions for the rest of the year. The cap is $2,100 in 2026 and $2,400 in 2027, and it applies whether you have a stand-alone Part D plan or drug coverage built into a Medicare Advantage plan.
A few things count toward that cap and a few don't:
- Counts: What you pay for covered Part D drugs at the pharmacy — deductibles, copays, and coinsurance.
- Doesn't count: Your monthly premium, over-the-counter items, and drugs your plan doesn't cover.
The Part D annual deductible can also be no higher than $615 in 2026 and $700 in 2027, according to CMS.
Goodbye, "donut hole"
If you've been on Medicare for a while, you probably remember the coverage gap — the so-called "donut hole" — where costs would jump after you hit a spending threshold, then drop again in "catastrophic" coverage. That gap was eliminated in 2025.
Part D now has just three phases:
1. Deductible phase — you pay full negotiated price until you meet the deductible (up to $615 in 2026, $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance while the plan pays the rest. 3. Catastrophic phase — once you hit the annual out-of-pocket cap ($2,100 in 2026, $2,400 in 2027), you pay nothing more for covered drugs that year.
For anyone taking expensive specialty medications, this is the change with the biggest real-world impact. Instead of costs stacking up all year, they stop at a known number.
The Medicare Prescription Payment Plan
Even with the cap, paying $2,400 all at once — or even a large pharmacy bill in January — can be tough on a fixed income. That's where the Medicare Prescription Payment Plan comes in.
It's optional and free to join. Here's how it works:
- Instead of paying the pharmacy at the counter, you pay $0 there.
- Your Part D plan bills you monthly for what you would have owed, spread out across the remaining months of the year.
- You still pay the same total amount — it's just smoothed into predictable monthly bills.
This can be especially helpful if you have a big prescription cost early in the year. It's not a discount program, and it doesn't lower your drug prices — it just changes the timing. You can sign up through your Part D plan before or during the year.
What this means locally in Antioch
Antioch is in Contra Costa County, where beneficiaries choose from a range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. Every one of those plans — no matter the carrier — has to follow the same federal rules: the annual out-of-pocket cap ($2,400 in 2027), the maximum deductible ($700 in 2027), and access to the payment plan. The 2027 plan lineup is in each plan's ANOC and on Medicare.gov's Plan Finder.
What still varies from plan to plan is the formulary (the list of covered drugs), the pharmacy network, and how a drug is tiered. That's why two neighbors on the same street can have very different pharmacy bills even under the new cap. Reviewing your plan each fall — using your actual medication list — is the single most useful thing you can do during AEP.
A quick note on IRMAA
Higher-income beneficiaries pay an extra amount, called IRMAA, on top of their Part B and Part D premiums. For 2026, IRMAA surcharges kick in above $109,000 in income for a single filer (higher for joint filers). If your income has dropped because of retirement or another life event, you can ask Social Security to reconsider using Form SSA-44.
Key dates to circle
- Oct. 15 – Dec. 7, 2026: Medicare Annual Enrollment Period. Change your Part D or Medicare Advantage plan for 2027.
- Jan. 1, 2027: New $2,400 out-of-pocket cap takes effect.
- Jan. 1 – March 31, 2027: Medicare Advantage Open Enrollment Period. If you're already in a Medicare Advantage plan, you get one chance to switch.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Contra Costa County
(MA penetration in Contra Costa County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) is eliminated as of 2025 (three phases now). There's a hard yearly cap on what you pay out of pocket for covered drugs — $2,100 in 2026 and $2,400 in 2027 — and you can spread those costs across the year with the Medicare Prescription Payment Plan.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Q: Does the $2,100 cap include my monthly premium?
Q: If I sign up for the payment plan, do I save money?
Q: I don't take many drugs. Do I still need to pay attention?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.