Medicare Part D

How the $2,100 Part D Cap Works in Little Rock

LITTLE ROCK, Ark. — Starting Jan. 1, 2026, no one with Medicare Part D will pay more than $2,100 out of pocket for covered prescription drugs in a calendar year. It's the biggest shift in Part D since the program began, and for people in Little Rock and across Pulaski County who take costly medicines, it changes the math on how a year of prescriptions actually plays out.

Here's what to know before the Annual Enrollment Period closes on Dec. 7.

The $2,100 cap, in plain English

The Part D out-of-pocket maximum set by the Centers for Medicare & Medicaid Services (CMS) is $2,100 in 2026 and $2,400 in 2027. Once your spending on covered drugs hits that number, you pay nothing more for the rest of the plan year on any drug your plan covers.

That cap applies whether you have a stand-alone Part D drug plan or a Medicare Advantage plan that includes drug coverage. It replaces the old system, where a person on expensive specialty medications could spend many thousands of dollars a year at the pharmacy counter.

Two other program-level figures to keep in mind:

• The maximum Part D deductible for 2026 is $615. Plans can charge less, but not more.
• Only what you pay for covered drugs counts toward the cap. Premiums do not count.

The "donut hole" is gone — for good

If you or a family member has been on Medicare a while, you've probably heard about the coverage gap, or "donut hole" — the stretch where costs used to jump partway through the year.

That phase was eliminated in 2025. In 2027, Part D has just three phases:

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

No more middle "gap" where costs spike. It's a cleaner design, and it makes the yearly ceiling predictable.

The Medicare Prescription Payment Plan

Here's the part a lot of people miss. Hitting the yearly ceiling is good news over a full year — but if a big prescription lands in January, you could still owe a large amount in a single month.

That's what the Medicare Prescription Payment Plan is for. It's a free, optional program run through your Part D plan. Instead of paying the pharmacy directly, you let your plan spread your out-of-pocket drug costs across the remaining months of the year in monthly bills.

A few things to understand about it:

• It doesn't lower what you owe overall — it just smooths the timing.
• You have to opt in. It isn't automatic.
• You can sign up before the plan year starts or any time during the year.
• If you miss a monthly payment, you can be removed from the program, so it's best used when the monthly bill will fit your budget.

For someone who takes a single high-cost specialty drug, opting in during January can be the difference between a manageable monthly payment and a painful one-time bill.

Common mistakes to avoid this fall

The Annual Enrollment Period runs Oct. 15 through Dec. 7. A few slip-ups we see year after year:

• Assuming your current plan is unchanged. Every plan sends an Annual Notice of Change (ANOC) in September. Read it. Formularies (the list of covered drugs) and pharmacy networks can shift.
• Skipping the drug list check. The out-of-pocket cap only applies to drugs your plan covers. If a medication isn't on the formulary, those costs generally don't count toward the cap.
• Confusing the cap with a premium cap. The cap is on out-of-pocket drug costs. Monthly premiums are separate.
• Forgetting IRMAA. Higher-income beneficiaries pay an income-related surcharge on Part B and Part D. For 2026, IRMAA begins above $109,000 in income for a single filer (based on your 2024 tax return).

What this means locally

Little Rock is in Pulaski County, where Medicare beneficiaries have a range of stand-alone Part D and Medicare Advantage options to compare each fall. The exact number of plans available shifts year to year as carriers file for 2026, and specifics — premiums, drug lists, pharmacy networks — differ from plan to plan.

The right tool for a personalized comparison is the Plan Finder at Medicare.gov, where you can enter your prescriptions and ZIP code and see what each plan would cost you. For free one-on-one help, Arkansas's SHIIP (Senior Health Insurance Information Program) offers unbiased counseling to Medicare beneficiaries.