Medicare Part D

$2,400 drug cap hits Glen Cove Medicare in 2027

GLEN COVE, N.Y. — Starting Jan. 1, 2027, people with Medicare Part D drug coverage will pay no more than $2,400 out of pocket for prescriptions in a calendar year. That's the third year of a hard cap on drug spending, rising from $2,100 in 2026 and from the $2,000 limit set in 2025. For many older adults on the North Shore who juggle several prescriptions, this is one of the biggest changes to Medicare in a generation.

Here's what to know before the Annual Enrollment Period closes on Dec. 7.

The Part D cap, in plain English

Once your out-of-pocket spending on covered Part D drugs hits $2,400 in 2027, you pay $0 for the rest of the year on those drugs. That cap applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan with drug coverage.

A few important details from Medicare:

• The cap counts what you pay for covered drugs — deductibles and copays that go through your plan.
• It does not count your monthly premium.
• It does not count drugs your plan doesn't cover, or drugs bought outside the plan's pharmacy network.

The Part D deductible can also be as high as $700 in 2027, though plans can set it lower. After the deductible, you move into cost-sharing until you hit the $2,400 ceiling.

The "donut hole" is gone — really gone

For years, Part D had a confusing middle stage called the coverage gap, or "donut hole," where your share of drug costs jumped after you and your plan spent a certain amount together. That phase was eliminated in 2025.

Now Part D has just three phases:

1. Deductible (if your plan has one) — you pay full negotiated price until you meet it. 2. Initial coverage — you pay a copay or coinsurance; your plan pays the rest. 3. Catastrophic coverage — once your out-of-pocket total reaches $2,400, you pay nothing more for covered drugs that year.

No more surprise price spike halfway through the year. That alone is worth a fresh look at your coverage during open enrollment.

The Medicare Prescription Payment Plan: monthly smoothing

The cap helps with the total, but $2,400 in January is still a lot to swing at once. That's where the Medicare Prescription Payment Plan comes in — a free, optional program that lets you spread your Part D out-of-pocket costs across the calendar year in monthly payments instead of paying the pharmacy up front.

A few things to understand before you sign up:

• You still owe the same total; the plan just changes when you pay it.
• You pay the pharmacy $0 at the counter for covered drugs; your plan bills you monthly.
• Miss a payment and you can be removed from the program (though you keep your drug coverage).
• It tends to help most people whose drug costs are high early in the year, like someone starting an expensive specialty medication in January.

Every Part D plan and every Medicare Advantage plan with drug coverage must offer this option in 2027. You can opt in before the year starts or any month during the year by contacting your plan.

Mistakes to avoid this fall

A few pitfalls we're hearing about from SHIP counselors and pharmacists:

• Assuming your current plan is still your best fit. Plans change their drug lists (formularies), pharmacy networks, and cost-sharing every year. Read the Annual Notice of Change your plan mailed in September.
• Forgetting to compare on medicare.gov. The Plan Finder at medicare.gov lets you enter your specific drugs and pharmacies and see estimated yearly costs under each plan available where you live.
• Skipping the payment plan when it would help — or joining when it wouldn't. If your drug costs are low and steady, monthly smoothing may not do much for you. If you're hit with a big bill in January, it can be a lifeline.
• Missing Dec. 7. After that, you generally can't change Part D coverage until next fall, unless you qualify for a Special Enrollment Period. Medicare Advantage members do get a second window — Jan. 1 to March 31 — to switch Advantage plans or return to Original Medicare.

What this looks like in Glen Cove

Glen Cove is in Nassau County, where Medicare beneficiaries can choose from a wide range of stand-alone Part D plans and Medicare Advantage plans with drug coverage. Availability and specific plan details are set at the county level by the Centers for Medicare & Medicaid Services (CMS), so two neighbors on the same street will see the same menu of options — but the right choice depends on the drugs each person takes.

For personalized help at no cost, New York's State Health Insurance Assistance Program (SHIP) — known here as HIICAP — offers one-on-one counseling through the Nassau County Office for the Aging.