Medicare Advantage
Part D in Sioux Falls: 2027 cap & changes
Minnehaha County has 21 Medicare Advantage plans for 2027. Compared with 2026, 6 plans are not coming back, 5 are new, and 15 continuing plans changed in some way you should check before December 7, 5 of them under a new name. This guide covers what those numbers mean for Sioux Falls, not which plan to pick.
Compare Medicare options near you
Answer 3 quick questions to see Medicare Advantage, Medigap, and Part D listings from licensed insurance partners.
What’s your ZIP code?
Plan availability is set by your county, so we start here.
How old are you?
This helps match you with options you’re eligible for.
Do you have Medicare Parts A & B?
Most Medicare Advantage and Medigap options require both.
These listings are provided by licensed insurance partners.
Medicare Advantage plans in your area are changing or leaving for 2027.
One call tells you whether your plan is on the list — before enrollment opens.
Available now — current wait: 0 min
A real person answers. No phone menu, ever.
Want to see more plan options?
Answer a few more questions to continue to additional options from licensed partners.
Continue →Advertising disclosure: MyMedicarePlans.org may be compensated when you contact a partner or licensed agent. Listings are not ranked or endorsed by us, and we do not recommend specific plans. You can also contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Speak to a Licensed Insurance Agent
Click to call 855-729-3240Found a plan you like online?
One free call confirms it's actually right for you — online directories are wrong more often than you'd think.
- Your doctors — confirmed in-network for 2027
- Your prescriptions — checked against the plan's 2027 drug tiers
855-729-3240 · free · about 5 minutes
SIOUX FALLS, S.D. — Starting Jan. 1, 2027, no one with a Medicare Part D drug plan will pay more than $2,400 out of pocket for covered prescriptions in a calendar year. The cap first arrived at $2,100 in 2026, and it lands again in the middle of Fall Open Enrollment, which runs through Dec. 7.
Key takeaways
- Starting Jan. 1, 2027, people with Medicare Part D drug coverage will pay no more than $2,400 out of pocket for covered prescriptions in a calendar year, after which covered drugs cost $0 for the rest of the year.
- This new spending cap applies to every Part D plan, including drug coverage built into Medicare Advantage plans, but it only counts money spent on drugs your plan actually covers, not premiums or non-covered drugs.
- The old coverage gap, or "donut hole," that used to cause a mid-year cost spike was eliminated in 2025, leaving just three simple stages: deductible, initial coverage, and catastrophic coverage.
- People worried about hitting the $2,400 cap early in the year can sign up through their Part D plan for the free, optional Medicare Prescription Payment Plan, which spreads the same total costs into monthly installments instead of one big upfront bill.
For older adults in Sioux Falls who take expensive medications — think insulin, blood thinners, cancer pills, or specialty drugs for autoimmune conditions — the new ceiling can change the math on which plan makes sense next year. Here's a plain-language look at what's actually changing.
The Part D cap, in one sentence
Once your out-of-pocket spending on covered Part D drugs hits $2,400 in 2027, you pay $0 for the rest of the year on those covered prescriptions. That's a program-wide rule set by CMS — it applies to every Part D plan, whether you get drug coverage through a stand-alone Part D plan or built into a Medicare Advantage plan.
The cap only counts what you pay for drugs your plan covers. Premiums don't count toward it, and drugs your plan doesn't cover don't count either. That's why checking your plan's formulary during Open Enrollment matters so much.
The "donut hole" is gone
If you've been on Medicare for a while, you probably remember the coverage gap — the "donut hole" — where costs spiked in the middle of the year. That phase was eliminated in 2025.
Part D now has just three phases:
1. Deductible — up to $615 in 2026 and up to $700 in 2027 (plans can set a lower deductible, but not higher). 2. Initial coverage — you pay a share of the cost until you hit the annual out-of-pocket cap ($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 surprise jump in prices halfway through the year.
The Medicare Prescription Payment Plan
Even with a $2,400 ceiling in 2027, hitting that number early — say, from a single expensive prescription in January — can hurt. That's where the Medicare Prescription Payment Plan comes in.
It's a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying the pharmacy all at once. You still pay the same total; you just don't get hit with a big bill up front.
You can sign up through your Part D plan (either your stand-alone plan or the drug portion of your Medicare Advantage plan). Medicare.gov has a checklist to help you decide if the payment plan fits your situation — it tends to help people with high, front-loaded drug costs more than folks with steady, low costs.
What Sioux Falls shoppers should look at this fall
Sioux Falls is in Minnehaha County, where Medicare beneficiaries can choose from a range of stand-alone Part D plans and Medicare Advantage plans with drug coverage. For 2027, CMS Landscape files list 16 Medicare Advantage plans from 5 carriers in the county, down from 22 plans and 6 carriers in 2026. Plan availability, formularies, and pharmacy networks are set at the county level, so the options a neighbor in Lincoln County sees may look a little different.
A few things worth checking before Dec. 7:
- Your drugs on next year's formulary. Plans update their drug lists every year. A medication that was covered in 2026 may sit on a different tier — or be excluded — in 2027.
- Preferred pharmacies. Sanford, Avera, Lewis, Hy-Vee, Walmart, and Costco pharmacies in the Sioux Falls area may be treated differently by different plans.
- Your Annual Notice of Change (ANOC). Your current plan mailed this in September. It spells out what's changing in your coverage for 2027 — and among Minnehaha County plans continuing into 2027, 10 have changes in their terms.
A note on higher incomes (IRMAA)
Most people pay the standard Part B and Part D premiums. If your 2024 income was above $109,000 for a single filer (or $218,000 for a couple filing jointly), you'll pay an Income-Related Monthly Adjustment Amount, or IRMAA, on top of your Part B and Part D premiums in 2026. Social Security will notify you if this applies.
Key dates
- Oct. 15 – Dec. 7, 2026: Annual Enrollment Period. Switch, join, or drop Part D and Medicare Advantage plans for 2027.
- Jan. 1, 2027: New coverage begins. $2,400 cap takes effect.
- Jan. 1 – March 31, 2027: Medicare Advantage Open Enrollment. If you're in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare.
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 Minnehaha County
(MA penetration in Minnehaha 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”) was eliminated in 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.
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.
Explore
The parts of Medicare
Good to know
Frequently asked questions
Does the $2,100 cap include what my plan pays, or only what I pay?
If I sign up for the Prescription Payment Plan, do I pay less overall?
I take insulin. Is there still a separate cap for that?
- CMS — MA/Part D Landscape & Plan Finder data
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.