Medicare Advantage

Part D's $2,100 Cap Arrives in Salt Lake City in 2026

For 2027, Salt Lake County has 37 Medicare Advantage plans from 8 carriers: 4 new, 6 gone since 2026, and 13 continuing plans changed on something in their terms, with 9 renamed. Below, how the lineup shifted in Salt Lake County and what to compare, with no plan ranked or recommended.

SALT LAKE CITY — Starting January 1, 2027, no one with Medicare Part D will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year. That is a key change to watch this Annual Enrollment Period, and it lands right as Salt Lake City retirees are sitting down to compare their options before the December 7 deadline.

If you or someone you love takes an expensive medication — a cancer drug, a blood thinner, an insulin, a specialty biologic — this change matters. Here is what is actually new, what is not, and the mistakes to avoid before enrollment closes.

The $2,400 cap, in plain English

In 2027, once your out-of-pocket spending on covered Part D drugs hits $2,400, you pay $0 for the rest of the year on those drugs. This is a hard ceiling set by Medicare, and it applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan.

A few things to keep in mind:

• The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. It is indexed to rise a bit each year.
• Only what you pay counts toward the cap — deductibles, copays, and coinsurance on covered drugs.
• Monthly premiums do not count toward the cap.
• Drugs your plan does not cover (not on its formulary) do not count either.

The "donut hole" is gone — really gone

For years, Medicare drug coverage had four phases, including the dreaded coverage gap, or "donut hole," where costs could suddenly spike mid-year. That phase was eliminated in 2025 and stays gone in 2027.

Part D now has three phases:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (maximum allowed in 2027 is $700; plans can set it lower). 2. Initial coverage phase — you pay a copay or coinsurance for each prescription. 3. Catastrophic phase — after your out-of-pocket spending reaches $2,400, you pay nothing for covered drugs the rest of the year.

If you remember tracking your spending anxiously each summer to see when the donut hole would hit, you can stop. That math is over.

The Medicare Prescription Payment Plan: spread the cost

Here is the piece a lot of people miss. Even with the $2,400 cap, some folks hit big drug bills early in the year — say, a $1,400 pharmacy charge in January. To help with that, Medicare offers the Medicare Prescription Payment Plan (sometimes called "M3P" or "drug cost smoothing").

How it works:

• You opt in through your Part D or Medicare Advantage drug plan. It is free to join.
• Instead of paying the pharmacy at the counter, your plan bills you monthly for your drug share, spread across the remaining months of the year.
• Your total out-of-pocket cost for the year does not change — it is the same money, just spaced out.

This program can help if you would struggle to cover a large one-time drug bill. It is not automatic; you have to sign up. And if you rarely fill costly prescriptions, it may not help you at all — you would just be paying a monthly bill instead of small copays. Ask your plan whether it makes sense for your situation.

Enrollment in the Salt Lake City area

Salt Lake City is in Salt Lake County, where Medicare beneficiaries can choose from a range of stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. Plan lineups, formularies, and pharmacy networks are set at the county level and change every year — so a plan that fit you in 2026 may not be the same plan on paper in 2027.

Two dates to circle:

• October 15 – December 7, 2026: Medicare Annual Enrollment Period. This is when most people should compare drug plans for 2027.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you are already in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare.

You can compare plans available in your ZIP code — with your specific prescriptions plugged in — using the Plan Finder at medicare.gov.

Mistakes to avoid this fall

The $2,400 cap is real, but it is not a free pass. A few things trip people up:

• Assuming every drug counts. Only drugs on your plan's formulary count toward the cap. If your medication is not covered, you may pay the full price out of pocket and none of it applies.
• Ignoring the deductible. Plans can charge up to a $700 deductible in 2027 before coverage kicks in. That is a real bill in January.
• Skipping the annual review. Formularies, tiers, and preferred pharmacies change every year. Do not auto-renew without checking.
• Forgetting about IRMAA. Higher-income beneficiaries pay a surcharge on Part B and Part D premiums. In 2026, IRMAA starts above $109,000 in income for single filers (higher for joint filers). This does not change your drug costs at the pharmacy, but it does raise your monthly premium.
• Missing December 7. Miss it, and in most cases you are locked in until next fall.