Medicare Part D
Medicare's New $2,100 Drug Cap: What St. Pete Should Know
By the numbers
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Key takeaways
- Starting January 1, 2027, Medicare Part D out-of-pocket drug costs will be capped at $2,400 per year, after which covered drugs cost nothing more for the rest of the year.
- The old coverage gap, known as the "donut hole," is gone, leaving just three phases: deductible, initial coverage, and catastrophic.
- The optional Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs into monthly payments instead of paying a large bill at the pharmacy all at once.
- These are federal rules that apply to all stand-alone Part D and Medicare Advantage drug plans, so it's still worth comparing plans during the Annual Enrollment Period (October 15–December 7) since coverage, pharmacies, and costs before the cap can vary.
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 Pinellas County
(MA penetration in Pinellas 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.
St. Petersburg, Fla. — The Part D out-of-pocket cap rises in 2027
Starting January 1, 2027, the amount you can pay out of pocket for prescription drugs under Medicare Part D will be capped at $2,400 for the year. Once you hit that limit, you pay nothing more for covered drugs for the rest of the calendar year. The cap was $2,100 in 2026. For St. Petersburg residents who take costly medications — think insulin, blood thinners, cancer pills, or specialty injectables — this remains one of the most meaningful Medicare changes in years.
The cap applies whether you get your drug coverage through a stand-alone Part D plan or built into a Medicare Advantage plan. And the change arrives during Medicare's Annual Enrollment Period, which runs October 15 through December 7, 2026 — the window when you can compare plans for 2027.
What the $2,100 cap actually covers
The cap counts what you personally spend on covered Part D drugs — your deductible, copays, and coinsurance at the pharmacy. It does not include your monthly premium, and it does not apply to drugs Medicare Part D doesn't cover (for example, most over-the-counter medications, or drugs billed under Part B like many infusions given in a doctor's office).
A few other 2027 program-level numbers to keep in mind, according to CMS:
- Part D deductible: up to $700 in 2027 (plans can charge less, but not more).
- Out-of-pocket cap: $2,400 in 2027.
- IRMAA surcharges: kick in for single filers with income above roughly $109,000 (based on your 2024 tax return).
The "donut hole" is gone — for good
If you've been on Medicare for a while, you probably remember the coverage gap, better known as the donut hole. That awkward middle stage where your drug costs suddenly jumped is officially gone. Part D now has just three phases:
1. Deductible phase — you pay full negotiated price until you meet your plan's deductible. 2. Initial coverage phase — you pay copays or coinsurance until your out-of-pocket spending hits the annual cap ($2,400 in 2027). 3. Catastrophic phase — you pay nothing more for covered drugs the rest of the year.
That's it. No more donut hole math, no more sticker shock in the middle of the year.
The Medicare Prescription Payment Plan: spreading the cost
Here's the piece a lot of people in Pinellas County are still learning about. Even with the $2,400 cap in 2027, you could still owe a big bill in January or February if you fill an expensive prescription early in the year. To help with that, Medicare offers the Medicare Prescription Payment Plan — an optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying the pharmacy all at once.
A few things to know:
- It's free to join, and every Part D plan must offer it.
- You don't pay less overall — you pay the same total, just spread out.
- You can opt in before the year starts or at any point during the year.
- The pharmacy still gets paid; your plan bills you monthly.
This program tends to help most if you have high drug costs early in the year, or if a fixed-income budget makes a $600 pharmacy bill in January hard to absorb. If your prescriptions are inexpensive and steady, you may not need it at all.
What this means locally
St. Petersburg is in Pinellas County, which has one of the largest Medicare-eligible populations in Florida. Pinellas offers a wide range of stand-alone Part D and Medicare Advantage plans with drug coverage — plan availability is set at the county level by CMS, not by ZIP code or city. The $2,100 cap and the payment plan option apply to all of them equally; they are federal rules, not plan perks.
Because plans can still differ in which drugs they cover (their formulary), which pharmacies are in-network, and how much you'll pay before hitting the cap, it's worth comparing options during Annual Enrollment — even if you've been happy with your current plan. The 2027 lineup for your county is in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder.
How to compare before December 7
1. List your medications, including dosages. 2. Go to medicare.gov/plan-compare and enter your drugs and preferred pharmacies. The tool will estimate your yearly costs under each plan. 3. Check whether your regular pharmacy is a preferred in-network pharmacy — that often affects your copays. 4. If you want help from a real person, call 1-800-MEDICARE (1-800-633-4227), 24/7, or contact Florida's SHINE program (Florida's SHIP), a free counseling service for Medicare beneficiaries. In the Tampa Bay area, SHINE counselors work through the Area Agency on Aging of Pasco-Pinellas.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) was eliminated as of 2025, leaving three phases. 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
Does the $2,100 cap reset every year?
If I join the Prescription Payment Plan, do I save money?
Do I have to sign up for the payment plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.