Medicare Advantage

Part D's $2,100 Drug Cap Arrives for San Diego in 2026

People in San Diego can choose from 65 Medicare Advantage plans for 2027, against 93 this year. 26 of this year's plans are gone, 18 are new to San Diego County, and 28 that continue have changed their premium, deductible, plan type or name, 20 of them under a new name.

SAN DIEGO — If you've been watching your Medicare mail pile up, here's the number worth circling for 2027: $2,400. That's the yearly cap on what you'll pay out of pocket for covered Part D prescription drugs, no matter which plan you're enrolled in. For San Diego seniors juggling multiple medications, it remains one of the biggest cost-structure changes Medicare has seen in years — and it shapes how the math of choosing coverage works.

San Diego is in San Diego County, where 15 carriers offer Medicare Advantage plans for 2027, adding up to 65 Medicare Advantage options. That's a lot of paperwork to sort through, so understanding how the cost pieces fit together first can save you a lot of second-guessing later.

The building blocks of what you pay

Medicare's cost structure has several moving parts, and they don't all work the same way. It helps to picture them as separate buckets:

• Part B premium. Most people pay a standard monthly premium for outpatient care. Higher-income beneficiaries pay more (see IRMAA below).
• Part D or Medicare Advantage premium. This depends on the plan you pick. Some plans have low or no premium; others charge more in exchange for different features.
• Deductibles. Part D plans can charge a deductible up to $615 in 2026. Some charge less, some charge nothing on certain drug tiers.
• Cost-sharing. After the deductible, you pay a share of each prescription until you hit the annual cap.
• The out-of-pocket cap. Once your covered drug spending reaches the annual cap ($2,100 in 2026, $2,400 in 2027), you pay $0 for covered Part D drugs the rest of the calendar year.

That last piece is the newest and most protective. Before 2025, there was no hard ceiling.

How the new three-phase Part D works

Since 2025, Part D has three phases instead of four:

1. Deductible phase. You pay the full negotiated price until you meet your plan's deductible (up to $615 in 2026, up to $700 in 2027). 2. Initial coverage phase. You pay a copay or coinsurance; the plan pays the rest. 3. Catastrophic phase. Once your out-of-pocket spending hits the annual cap ($2,100 in 2026, $2,400 in 2027), you pay nothing for covered drugs the rest of the year.

The old "donut hole" — that awkward middle stretch where costs jumped — is gone. This makes it easier to predict your worst-case drug spending for the year.

The Medicare Prescription Payment Plan

Even with the annual cap, some people hit big bills early in the year on expensive medications. The Medicare Prescription Payment Plan is an optional program that lets you spread your Part D out-of-pocket costs into level monthly payments billed by your plan, rather than paying the pharmacy in one lump.

It doesn't lower your total cost — it smooths it out. If you take a high-cost drug in January, this can keep your first-quarter budget from getting hammered. You can opt in through your Part D or Medicare Advantage drug plan.

IRMAA: when higher income means higher premiums

If your income is above certain thresholds, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top of your standard Part B and Part D premiums. For 2026, IRMAA begins above $109,000 in income for a single filer (higher for joint filers). Social Security uses your tax return from two years back to figure this out, so a 2026 IRMAA is based on your 2024 return.

If your income has dropped since then — because of retirement, a spouse's death, or another life event — you can ask Social Security to reconsider using Form SSA-44.

Sorting through 65 options without losing your weekend

With 65 Medicare Advantage plans in San Diego County and 15 carriers for 2027, the choices can feel overwhelming. A few practical steps:

• Start with your drugs. Enter your prescriptions into the Plan Finder at medicare.gov. It shows how each plan would handle your specific medications.
• Add your doctors. Confirm whether preferred providers are in-network before you enroll.
• Compare total expected cost, not just premium. A plan with a higher premium and lower deductible could cost you less overall — or vice versa. The annual cap sets the ceiling for drug spending either way.
• Watch the calendar. The Annual Enrollment Period runs October 15 through December 7. Medicare Advantage Open Enrollment runs January 1 through March 31 if you need to change an Advantage plan choice.

Where to get unbiased help

You don't have to sort this out alone, and you don't have to talk to a salesperson to get answers.

• Medicare.gov — the official Plan Finder and program rules.
• 1-800-MEDICARE (1-800-633-4227) — 24/7 help from Medicare.
• California's SHIP (HICAP) — free, unbiased Medicare counseling. In San Diego, contact the local Health Insurance Counseling and Advocacy Program office for one-on-one help.