Medicare Part D
Medicare Coverage Gap Ends — Bella Vista, AR
BELLA VISTA, Ark. — Starting Jan. 1, 2026, the way Medicare pays for prescription drugs changes in a big way. For the first time, there will be a hard yearly limit on what people with a Part D plan pay out of pocket for their covered medicines: $2,100. Once you hit that number, you pay $0 for covered drugs for the rest of the calendar year.
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Key takeaways
- The Medicare Part D out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027. After you reach it, you pay nothing more for covered drugs that year.
- This cap and the Part D deductible ceiling are federal rules that apply to all Part D plans and Medicare Advantage plans with drug coverage, not just certain plans. The deductible ceiling is $615 in 2026 and $700 in 2027.
- The Medicare Prescription Payment Plan is a free, optional program that lets you spread your drug costs into monthly bills across the year instead of paying it all at the pharmacy.
- Plan choices are set by county, so it's worth checking each fall how a plan's formulary, pharmacy network, and premium fit your medications, even if you're happy with your current plan.
For Bella Vista residents who have watched drug prices climb, this is one of the most significant Medicare updates in years — and it arrives right as the Annual Enrollment Period (Oct. 15 – Dec. 7) wraps up.
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 Benton County
(MA penetration in Benton 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.
What changes for 2027
Three things are worth knowing up front:
- The out-of-pocket cap applies to what you personally spend on covered Part D drugs in a calendar year. It is $2,100 in 2026 and $2,400 in 2027. It replaces the old system that had no true ceiling.
- The Part D deductible can be no higher than $615 in 2026. Plans may charge less, but not more.
- The "donut hole" is gone. As of 2025, the coverage gap phase was eliminated. Part D now has just three phases: deductible, initial coverage, and catastrophic (where you pay $0 after hitting the cap).
These rules come from CMS — Medicare Part D program rules — and apply whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan.
Why the end of the coverage gap matters
For years, the donut hole was the part of Part D that confused people the most. You'd have steady copays early in the year, then suddenly pay a bigger share once your total drug costs crossed a threshold. That gap is now history.
In 2027, once your out-of-pocket spending on covered drugs adds up to $2,400, you move into catastrophic coverage — and you owe nothing more for the rest of the year on those covered drugs.
That's a meaningful safety net for anyone on high-cost medications for conditions like cancer, rheumatoid arthritis, or MS.
The Medicare Prescription Payment Plan: spreading costs over the year
Even with the cap, hitting $2,400 in January or February would still sting. That's where the Medicare Prescription Payment Plan comes in.
This is a free, optional program. Instead of paying the pharmacy the full cost of an expensive prescription at pickup, you can choose to have Medicare spread your out-of-pocket drug costs into monthly bills across the calendar year. You still owe the same total — it's just smoothed out.
A few things to know:
- You have to opt in. Your Part D or Medicare Advantage plan handles the enrollment.
- You can join before the plan year starts or at any point during the year.
- You pay the plan monthly, not the pharmacy.
- It doesn't lower your total costs — it just changes the timing.
For someone whose expensive prescriptions arrive early in the year, this can be the difference between filling a script and skipping it.
A local snapshot: Bella Vista and Benton County
Bella Vista is in Benton County, and Medicare plan availability is set at the county level. That means every Bella Vista resident chooses from the same menu of stand-alone Part D plans and Medicare Advantage plans with drug coverage that any other Benton County resident sees.
The $2,400 cap and the $700 deductible ceiling for 2027 apply across all of those plans — it's a federal rule, not a plan-by-plan perk. What varies from plan to plan is the formulary (which drugs are covered and at what tier), the pharmacy network, and the monthly premium. The 2027 plan lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder.
That's why comparing your specific medications against a plan's formulary each fall is worth the time — even if you liked your plan last year.
Dates to keep on the calendar
- Oct. 15 – Dec. 7, 2026: Annual Enrollment Period. Changes take effect Jan. 1, 2027.
- Jan. 1 – Mar. 31, 2027: Medicare Advantage Open Enrollment Period. If you're already in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare.
- Income above $109,000 (single filer, 2026): IRMAA surcharges kick in on Part B and Part D premiums.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) was eliminated as of 2025 (three phases now). The hard 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 out-of-pocket cap include my monthly premium?
If I don't take expensive drugs, does any of this matter to me?
Do I have to sign up for the Prescription Payment Plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.