Medicare Part D

$2,100: The New Medicare Drug Ceiling in West Palm Beach

WEST PALM BEACH, Fla. — If you take prescription drugs and have Medicare, 2027 brings a change worth understanding. The out-of-pocket ceiling on covered drugs rises to $2,400 for the year — and the old "donut hole" is gone. Here is a plain-language walk-through of how Part D works in 2027, what the phases look like, and where West Palm Beach readers can turn for personal help.

The big picture: what Part D covers

Part D is the part of Medicare that helps pay for prescription drugs you pick up at a pharmacy or get by mail. It is optional, and it is offered through private insurance companies that follow rules set by Medicare. You can get Part D two ways: as a stand-alone drug plan paired with Original Medicare, or built into a Medicare Advantage plan.

Every Part D plan has its own list of covered drugs (called a formulary) and its own pharmacy network. But the overall structure — the deductible, the phases, and the yearly cap — is set by Medicare.

The 2027 numbers you should know

Two program-wide figures shape what you'll pay in 2027:

• Deductible: Plans can charge up to $700 in 2027 before drug coverage kicks in. Some plans charge less; none can charge more.
• Yearly out-of-pocket cap: Once you've paid $2,400 out of pocket for covered drugs in 2027, you pay $0 for the rest of the calendar year on those drugs.

That cap — $2,100 in 2026 and $2,400 in 2027 — is the headline change people are still getting used to. Before 2024, there was no hard ceiling on what a Part D enrollee could spend in a year. Now there is.

The three phases of Part D in 2027

As of 2025, Medicare simplified Part D from four phases to three. The old coverage gap — the "donut hole" — is gone. Here is how the year now flows:

1. Deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible (up to $700 in 2027). Some plans waive the deductible on certain lower-cost drug tiers.

2. Initial coverage phase. Your plan starts sharing the cost. You pay a copay or coinsurance for each prescription; the plan pays the rest. You stay in this phase until your out-of-pocket spending on covered drugs reaches the yearly cap ($2,400 in 2027).

3. Catastrophic phase. Once you hit the yearly cap ($2,400 in 2027), you pay nothing for the rest of the year on drugs your plan covers. Your plan and Medicare pick up the tab.

One helpful note: only what you pay toward covered drugs counts toward the yearly cap. Your monthly premium does not count.

The Medicare Prescription Payment Plan

Introduced in 2025 and continuing in 2027, every Part D plan must offer an option called the Medicare Prescription Payment Plan. It lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying big amounts at the pharmacy counter.

You still owe the same total — this is not a discount program — but it can smooth out a January surprise if you take an expensive drug early in the year. You have to opt in; you can sign up through your plan.

What this looks like in West Palm Beach

West Palm Beach is in Palm Beach County, where Medicare beneficiaries have a wide selection of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. Plan availability is set at the county level, so two neighbors on the same block generally see the same menu of options.

Because formularies and pharmacy networks differ from plan to plan, the same drug can be covered differently by two plans in the same ZIP code. That is why Medicare recommends checking your specific medications against a plan's drug list before enrolling — not just comparing premiums.

A note on higher incomes (IRMAA)

If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your most recent tax return on file with Social Security, you may pay an Income-Related Monthly Adjustment Amount, or IRMAA, on top of your Part D premium. Social Security notifies you if this applies. You can appeal if your income has dropped due to a life event like retirement.

Key dates to circle

• Annual Enrollment Period: October 15 – December 7. This is when most people join, switch, or drop a Part D or Medicare Advantage plan for the following year.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance during these months to switch to another MA plan or return to Original Medicare (and add a stand-alone Part D plan).