Medicare Part D

The $2,100 Part D Cap Explained for Findlay Residents

The $2,100 Part D Cap Explained for Findlay Residents — plain-language Medicare information for Findlay, Ohio.

FINDLAY, Ohio — If you take prescription drugs and you're on Medicare, 2027 continues some of the biggest changes to Part D coverage in years. There's a higher out-of-pocket cap than last year, an updated ceiling on the yearly deductible, and — for a third year — no more "donut hole." Here's a plain-language look at how it all works.

The three phases of Part D in 2027

Part D used to have four phases, including the coverage gap most people called the donut hole. That gap was eliminated in 2025, so in 2027 there are still three phases:

1. Deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible. In 2026, no Part D plan can charge a deductible higher than $615, according to CMS. Some plans set a lower deductible, and some waive it for certain drug tiers. 2. Initial coverage phase. After you meet the deductible, you pay a copay or coinsurance for each prescription while your plan pays the rest. You stay in this phase until your out-of-pocket spending on covered drugs reaches the annual cap. 3. Catastrophic phase. Once you hit $2,100 in out-of-pocket costs on covered drugs in 2026, you pay $0 for the rest of the calendar year on those drugs. This is the new hard cap Medicare created, and it applies to everyone with Part D.

That cap ($2,100 in 2026, $2,400 in 2027) is the number most people will want to remember. Before 2024, there was no yearly limit on what you could spend out of pocket for prescriptions under Part D.

What the $2,100 cap actually means

The cap counts what you pay out of pocket for drugs that are covered by your plan's formulary. It does not include your monthly premium, and it does not include drugs your plan doesn't cover.

Once you reach $2,400 in 2027, you're done paying at the pharmacy counter for the rest of the year on your covered prescriptions. Your plan and Medicare pick up the cost from there.

Spreading payments out with the Payment Plan

Hitting a big drug bill early in the year can be hard on a fixed income. That's why Medicare also offers the Medicare Prescription Payment Plan, sometimes called "M3P" or drug cost smoothing.

Here's the idea: instead of paying a large amount at the pharmacy in a single month, you can opt in and have your Part D plan bill you monthly, spreading your share of the costs across the calendar year. You still pay the same total, but the timing is smoother. Enrollment is free and voluntary, and you sign up through your Part D plan.

A quick local snapshot

Findlay is in Hancock County, where Part D coverage is offered both as stand-alone drug plans (added to Original Medicare) and as part of many Medicare Advantage plans. The specific plans, formularies, and pharmacy networks vary, so the same medication can be handled very differently from one plan to the next.

The rules above — the $700 maximum deductible, the $2,400 out-of-pocket cap, and the three phases — apply the same way in 2027 across every Part D plan sold in Hancock County. What changes between plans is the deductible amount, the tier structure, and which drugs are on the formulary.

Enrollment dates to keep on the fridge

• Annual Enrollment Period: October 15 – December 7. This is when most people can 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 this window to switch to another Medicare Advantage plan or return to Original Medicare (and add a stand-alone Part D plan).

If you take expensive medications, it's worth reviewing your plan every fall. Formularies and drug tiers can change from year to year, even if your prescriptions haven't.

A note on higher-income enrollees

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 the IRS, you'll pay an IRMAA surcharge on top of your Part D premium in 2026. Social Security notifies you by mail if this applies. You can appeal if you've had a life-changing event, like retirement, that lowered your income.