Medicare Part D
2027 Medicare drug cap & payment plan: Carlisle
CARLISLE, Pa. — On Jan. 1, 2027, the ceiling on what people with Medicare drug coverage pay out of pocket for prescriptions moves to $2,400 for the year, up from $2,100 in 2026. Once you reach it, you pay $0 for covered drugs at the pharmacy for the rest of the calendar year. The hard cap, now in its second year, lands right as Medicare's Annual Enrollment Period (Oct. 15 – Dec. 7) is underway.
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Click to call 855-729-3240Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, and once you hit that ceiling you pay $0 for covered drugs for the rest of the year.
- The old Part D "donut hole" coverage gap is gone for good, so there are only three phases now: deductible, initial coverage, and catastrophic coverage.
- A free, optional Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs into monthly payments instead of paying it all at the pharmacy, though it doesn't lower your total cost.
- Medicare's Annual Enrollment Period runs October 15 through December 7, with changes taking effect January 1, 2027, and Medicare Advantage enrollees get another chance to switch plans from January 1 through March 31, 2027.
Here's a plain-language look at what's changing, what stays the same, and how a new monthly payment option can spread those costs across the year.
The $2,400 cap for 2027, explained
For 2026, Medicare caps what enrollees pay out of pocket for covered Part D drugs at $2,100, up slightly from the $2,000 cap that took effect in 2025. The cap applies to your deductible, copays, and coinsurance on covered prescriptions — it does not include your monthly plan premium.
The maximum Part D deductible for 2026 is $615, though many plans set theirs lower. After you meet whatever deductible your plan uses, you move into the initial coverage phase, and once your out-of-pocket spending reaches $2,100 in 2026 ($2,400 in 2027), you enter the catastrophic phase and pay nothing more for covered drugs that year.
If you're on Medicare and taking expensive brand-name medications — insulin, cancer drugs, blood thinners, MS therapies — this is the change most likely to affect your household budget.
Yes, the "donut hole" is really gone
For years, the Part D coverage gap — nicknamed the "donut hole" — was the phase where people suddenly paid a bigger share of their drug costs after their plan hit a spending limit. That gap was eliminated in 2025 and remains gone in 2027.
Part D now has just three phases:
1. Deductible (if your plan has one, up to $615 in 2026 ($700 in 2027)). 2. Initial coverage — you pay copays or coinsurance until your out-of-pocket costs hit $2,100 in 2026 ($2,400 in 2027). 3. Catastrophic coverage — you pay $0 for covered drugs the rest of the year.
That's it. No more fourth phase. No more surprise price jump mid-year.
The Medicare Prescription Payment Plan
Hitting the $2,100 in 2026 ($2,400 in 2027) ceiling early in the year can still be painful if it happens in one pharmacy trip. That's where the Medicare Prescription Payment Plan comes in.
This is a free, optional program that lets you spread your Part D out-of-pocket costs across monthly payments over the calendar year, instead of paying the full amount at the pharmacy counter. You still owe the same total — the plan doesn't lower your drug costs — but it smooths the bill.
A few things to know:
- You opt in through your Part D or Medicare Advantage drug plan. Every plan is required to offer it.
- You can join before the plan year starts or any month during the year.
- The pharmacy charges $0 at pickup for covered drugs; your plan bills you monthly.
- It tends to help most if you have high drug costs early in the year. It may not help — and could even feel awkward — if your drug spending is low and steady.
What this means for Annual Enrollment
Carlisle is in Cumberland County, where residents can compare stand-alone Part D plans and Medicare Advantage plans that include drug coverage during AEP, which runs Oct. 15 through Dec. 7. Any change you make takes effect Jan. 1, 2027. The 2027 plan lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder.
A few smart moves this season:
- Run your drug list through Medicare's Plan Finder at medicare.gov. Formularies (the list of covered drugs) and pharmacy networks change every year, even if your plan's name doesn't.
- Check the deductible and tier placement for each of your prescriptions, not just the premium.
- Ask about the payment plan if you know you'll have high costs early in the year.
If you're already in a Medicare Advantage plan and want to switch after Jan. 1, the Medicare Advantage Open Enrollment Period runs Jan. 1 – March 31, 2027.
A quick note on higher-income enrollees
If your income is above $109,000 as a single filer (or $218,000 filing jointly) on your 2024 tax return, you may pay an IRMAA surcharge on top of your Part B and Part D premiums in 2026. IRMAA doesn't affect the cap ($2,100 in 2026, $2,400 in 2027) — that ceiling applies regardless of income — but it's worth knowing about when you compare total costs.
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 Cumberland County
(MA penetration in Cumberland 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”) is eliminated as of 2025 (three phases now). The yearly cap on what you pay out of pocket for covered drugs is $2,100 in 2026 and $2,400 in 2027, 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 $2,400 cap include my monthly premium?
What if my drug isn't on my plan's formulary?
Do I have to sign up for the payment plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.