Medicare Part D

Why Medicare's Coverage Gap Ends for Euclid Households

EUCLID, Ohio — 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 how seniors pay for medicine in nearly two decades, and for households in Euclid it lands right in the middle of Medicare's Annual Enrollment Period, which runs Oct. 15 through Dec. 7.

Here's what's changing, what's staying the same, and where to get straight answers.

The $2,100 cap, in plain English

For 2027, Medicare Part D has a hard ceiling on what you can spend out of pocket for covered prescription drugs: $2,400 for the year. Once you hit that number — through deductibles and copays or coinsurance on covered drugs — your Part D plan pays 100% of the cost of your covered medicines for the rest of the year.

That cap applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan that includes drug coverage. The annual Part D deductible can be no higher than $700 in 2027, though many plans set it lower.

This is a program-wide rule set by Medicare, not a promotion from any specific plan.

The "donut hole" is gone

If you or a family member has been on Medicare for a while, you may remember the dreaded coverage gap — the "donut hole" — where costs suddenly jumped after you and your plan had spent a certain amount on drugs.

That phase went away in 2025. Part D now has just three phases:

1. Deductible (if your plan has one). 2. Initial coverage, where you pay a copay or coinsurance. 3. Catastrophic coverage, which now kicks in once you hit the annual out-of-pocket cap — meaning $0 for covered drugs the rest of the year once you reach $2,400 in 2027.

For people in Euclid managing several prescriptions, that's a much simpler picture than the one that existed just a couple of years ago.

The Medicare Prescription Payment Plan

Hitting a $2,100 ceiling is good news over a full year, but drug costs don't always arrive evenly. A pricey specialty medication in January can strain a fixed income even if you know you'll be capped later.

That's what the new Medicare Prescription Payment Plan is designed to help with. It's optional, and it's free to join. Instead of paying the pharmacy the full cost-share at the counter, you can choose to have your Part D plan spread your out-of-pocket drug costs into monthly bills across the calendar year.

A few things worth knowing:

• It doesn't lower your total drug costs — it smooths them out.
• You sign up through your Part D plan (not at the pharmacy).
• You can join any time during the year, though joining earlier gives you more months to spread costs across.
• It may not make sense for everyone; people with modest, steady drug costs sometimes prefer to keep paying at the counter.

If you're unsure whether the payment plan fits your situation, that's exactly the kind of question 1-800-MEDICARE and Ohio's SHIP counselors are there to answer — for free.

What this means during Euclid's enrollment window

Euclid is in Cuyahoga County, where Medicare beneficiaries can choose from a wide selection of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. For 2027, Cuyahoga County has 93 Medicare Advantage plans from 16 carriers, with 18 new plans, 31 not returning, and 6 renamed. Specific plans, formularies, and pharmacy networks change every year — sometimes significantly — so a plan that was a good fit in 2025 or 2026 may not be the best match for 2027.

During Annual Enrollment (Oct. 15 – Dec. 7), it's worth doing three things:

• Check that your prescriptions are still on your plan's formulary for 2027.
• Confirm your regular pharmacy is still in-network.
• Look at how your plan handles the $2,400 cap in 2027 and whether it offers the payment plan.

If you're already in a Medicare Advantage plan, you also have the Medicare Advantage Open Enrollment Period from Jan. 1 to March 31 to switch to a different Advantage plan or return to Original Medicare.

A quick note on higher-income households

Most people pay the standard Part B and Part D premiums. But if your income is above $109,000 as a single filer (or the corresponding threshold for joint filers) in 2026, you may pay an income-related monthly adjustment amount (IRMAA) on top of your premiums. Medicare uses your IRS return from two years earlier to make that determination.

If your income has dropped because of a life event — retirement, loss of a spouse, reduced work hours — you can ask Social Security to reconsider.