Medicare Advantage

Why the coverage gap ends for North Charleston Medicare users

NORTH CHARLESTON, S.C. — If you take prescription drugs and have Medicare, 2027 continues one of the biggest shifts in years: a hard yearly limit on what you pay out of pocket at the pharmacy. Here's a plain-language look at how Part D works now, what the numbers mean, and where to get personal help.

What Part D actually is

Part D is the part of Medicare that helps pay for prescription drugs you pick up at a pharmacy or get by mail order. It's sold through private insurance companies that follow rules set by Medicare. You can get it two ways: as a stand-alone drug plan added to Original Medicare, or built into a Medicare Advantage plan that also covers hospital and doctor visits.

Every Part D plan has its own list of covered drugs (called a formulary), its own pharmacy network, and its own monthly premium. But the structure — how your costs move through the year — is set by Medicare, and that structure changed meaningfully in 2025 and continues in 2026.

The three phases in 2027

Since 2025, Part D has three payment phases instead of four. The old "donut hole" coverage gap is gone. Here's how the phases work in 2027, according to CMS:

1. Deductible phase. You pay the full negotiated price for your drugs until you meet the plan's deductible. In 2026, no Part D plan can charge a deductible higher than $615. Some plans charge less, and some cover certain drugs before the deductible is met.

2. Initial coverage phase. After the deductible, you pay a copay or a share of the cost for each prescription, and the plan pays the rest. You stay in this phase until your out-of-pocket spending on covered drugs reaches the yearly cap.

3. Catastrophic phase. Once your out-of-pocket spending on covered drugs hits the yearly cap — $2,100 in 2026 and $2,400 in 2027 — you pay nothing for the rest of the calendar year on drugs covered by your plan. That's the hard cap, and for people with high drug costs, it's the headline change.

The Medicare Prescription Payment Plan

Also new since 2025: every Part D plan must offer the Medicare Prescription Payment Plan, sometimes called "M3P" or drug cost smoothing. It doesn't lower your total drug costs, but it lets you spread what you owe across monthly bills from your plan instead of paying big amounts at the pharmacy counter.

This can be helpful if you have an expensive prescription early in the year and don't want to pay hundreds of dollars in January. You have to opt in — it isn't automatic. You can sign up through your plan at any point during the year.

A quick note on higher-income surcharges

If your income is above certain thresholds, you'll pay an extra amount on top of your Part D premium called IRMAA (Income-Related Monthly Adjustment Amount). For 2026, IRMAA begins for single filers with income above $109,000, and higher levels for joint filers. Social Security uses your tax return from two years ago to decide. If your income has dropped since then — because of retirement, for example — you can ask Social Security to reconsider.

What's available in the North Charleston area

Plan availability in Medicare is set at the county level, not by city. North Charleston is in Charleston County, where residents can compare stand-alone Part D plans and Medicare Advantage plans with drug coverage during the Annual Enrollment Period. To see the current list of plans available in Charleston County — and how each one covers your specific medications — use the Plan Finder at medicare.gov and enter your ZIP code and drug list.

We don't rank plans here, and we don't list benefits. The right plan depends on the exact drugs you take, the pharmacies you use, and your budget.

Key dates to remember

• October 15 – December 7: Medicare Annual Enrollment Period. You can join, switch, or drop a Part D plan or a Medicare Advantage plan. Changes take effect January 1.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you can switch to another one or return to Original Medicare (with a stand-alone Part D plan).

Missing these windows usually means waiting a year, unless you qualify for a Special Enrollment Period (for example, if you move or lose other drug coverage).

How to decide what fits you

A few questions worth answering before you pick or keep a plan:

• What drugs am I taking, and are they on the plan's formulary? A low premium doesn't help if your medication isn't covered.
• Which pharmacies are "preferred" in the plan's network? Cost-sharing is often different at preferred pharmacies.
• Am I likely to hit the $2,100 cap? If yes, the smoothing plan may make monthly costs easier to handle.
• Do I qualify for Extra Help? This federal program lowers Part D costs for people with limited income and resources. You can apply anytime through Social Security.