Medicare Part D
Jan. 1, 2027 Medicare Part D Updates — Saratoga Springs
SARATOGA SPRINGS, N.Y. — Starting Jan. 1, 2026, no one with a Medicare Part D drug plan will pay more than $2,100 out of pocket for covered prescriptions in a calendar year. It's the biggest change to Medicare drug coverage in years, and for people who take costly medications, it removes a worry that used to stretch into the tens of thousands of dollars.
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Will your prescriptions still be covered in 2027?
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Key takeaways
- Starting January 1, 2027, Medicare Part D drug plans cap out-of-pocket prescription costs at $2,400 per year, after which covered drugs cost nothing for the rest of the year.
- This $2,400 cap counts your deductible plus any copays or coinsurance you paid at the pharmacy, and it applies to every Part D plan and Medicare Advantage plan with drug coverage.
- The old coverage gap, known as the "donut hole," was eliminated in 2025 and remains gone in 2027, leaving Part D with just three phases: deductible, initial coverage, and catastrophic coverage.
- An optional Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs into monthly installments across the year instead of paying it all at once, and you sign up through your Part D or Medicare Advantage plan rather than through Medicare directly.
Here in Saratoga Springs — part of Saratoga County — the change lands right as the Annual Enrollment Period wraps up on Dec. 7. If you haven't reviewed your drug coverage for 2027, this is the moment to do it, because the new cap is only one of several rules shifting under Part D.
The Part D cap, in plain English
For 2026, once your out-of-pocket spending on covered Part D drugs hits $2,100, you pay $0 for the rest of the year on those drugs. That total includes your deductible and any copays or coinsurance you paid at the pharmacy for covered medications.
A few things it does not include:
- Your monthly Part D premium
- Drugs your plan doesn't cover
- Over-the-counter items
The cap is set by Medicare and applies to every Part D plan, whether you get drug coverage through a standalone Part D plan or a Medicare Advantage plan that includes drugs.
The "donut hole" is gone — really
If you remember dreading the coverage gap (the "donut hole"), you can let that worry go. Medicare eliminated the gap in 2025, and 2027 keeps that structure. Part D now has just three phases:
1. Deductible — the Part D maximum deductible is $615 in 2026 and $700 in 2027 (some plans set it lower). 2. Initial coverage — you pay a share of the cost until you reach the annual out-of-pocket cap. 3. Catastrophic coverage — after the cap, you pay nothing for covered drugs the rest of the year.
That's it. No more falling into a middle phase where prices spiked.
The Medicare Prescription Payment Plan: spreading costs across the year
Even with the annual ceiling, a big pharmacy bill in January can still be hard to absorb. That's why Medicare created the Medicare Prescription Payment Plan, an optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying it all at the counter.
Key points to know:
- It's free to join, but you have to opt in — it doesn't happen automatically.
- You still pay the same total; you just pay it monthly to your plan instead of at the pharmacy.
- You can sign up before the year starts or any month during the year.
- It tends to help most if you have high drug costs early in the year.
You sign up through your Part D or Medicare Advantage drug plan, not through Medicare directly.
Common mistakes to avoid during this enrollment season
With so many moving parts, a few missteps come up again and again:
- Assuming your current plan still fits. Formularies (the list of covered drugs), pharmacy networks, and premiums can change every year. Read your plan's Annual Notice of Change before Dec. 7.
- Skipping the payment plan when it would help. If you take an expensive brand-name drug, opting in early can prevent a large January bill.
- Forgetting about IRMAA. Higher-income beneficiaries pay a Part D surcharge. For 2026, IRMAA begins above $109,000 in income for a single filer (based on your 2024 tax return).
- Missing the deadlines. Annual Enrollment runs Oct. 15 – Dec. 7. If you're in a Medicare Advantage plan, you also get a second window — Jan. 1 – March 31 — to switch Advantage plans or return to Original Medicare.
Saratoga Springs is in Saratoga County, where the number of available Part D and Medicare Advantage plans is set at the county level. The 2027 lineup is detailed in each plan's Annual Notice of Change and on the Plan Finder at medicare.gov, which is the official tool for comparing what's offered in your ZIP code.
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 Saratoga County
(MA penetration in Saratoga 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”) was eliminated as of 2025 (three phases now). There’s a hard yearly cap of $2,400 in 2027 on what you pay out of pocket for covered drugs, 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 include my monthly premium?
If I don't take expensive drugs, does the cap matter to me?
Do I have to sign up for the payment plan every year?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.