Medicare Part D

Aurora Medicare Part D gets a $2,100 yearly drug cap

AURORA, Colo. — The hard, yearly ceiling on what Medicare Part D enrollees pay out of pocket for prescriptions, which began Jan. 1, 2026, continues in 2027 at a higher amount. The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once you hit it, you pay nothing more for covered drugs for the rest of the calendar year.

This is the biggest change to Medicare's drug benefit in nearly two decades, and it lands right in the middle of Fall Open Enrollment, which runs Oct. 15 through Dec. 7. Here's a plain-English look at what's new, what's gone, and how to think it through.

The $2,100 cap, explained simply

The Part D out-of-pocket cap on covered prescription drugs is $2,100 in 2026 and $2,400 in 2027. This applies whether you get your drug coverage through a stand-alone Part D plan or built into a Medicare Advantage plan with drug coverage.

A few things to keep in mind:

• The cap only counts money spent on covered drugs at in-network pharmacies. Drugs your plan doesn't cover don't count toward it.
• Premiums do not count toward the $2,100. Only your deductible, copays, and coinsurance on covered drugs do.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027. Plans can set it lower, but not higher.

Once you cross $2,100 in out-of-pocket drug spending, you're done paying for the year on covered prescriptions.

The coverage gap ("donut hole") is gone

If you've had Part D for a while, you probably remember the "donut hole" — that awkward middle phase where your share of drug costs suddenly went up until you hit catastrophic coverage. That phase was eliminated in 2025 and remains gone in 2027.

Part D now has three straightforward 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 copays or coinsurance while the plan pays the rest. 3. Catastrophic phase — once your out-of-pocket spending reaches the yearly cap ($2,400 in 2027), you pay $0 for covered drugs.

No more surprise jump in the middle of the year. That alone is a big deal for people on expensive maintenance medications.

The Medicare Prescription Payment Plan

Here's a piece many people miss. Even with the new cap, someone taking a pricey drug could still hit that $2,100 quickly — possibly in a single pharmacy visit early in the year. That's a real budget shock.

To help, Medicare offers the Medicare Prescription Payment Plan (sometimes called "M3P"). It's optional and free to join. Instead of paying the pharmacy at pickup, you pay $0 at the counter and your Part D plan bills you monthly, spreading your out-of-pocket drug costs across the calendar year.

A few important notes:

• It doesn't lower what you owe overall — it just smooths the payments.
• You can opt in before the year starts or any time during the year by contacting your Part D plan.
• If you miss a monthly bill, you can be removed from the program, though you'd still keep your drug coverage.

This can help if a big drug cost early in the year would be hard to absorb all at once. It's less useful if your drug costs are steady and modest month to month.

What this means during Open Enrollment

Aurora is in Arapahoe County, where — like everywhere in the country — Medicare beneficiaries can compare stand-alone Part D and Medicare Advantage drug plans during the Oct. 15–Dec. 7 window. For 2027, Arapahoe County has 48 Medicare Advantage plans from 11 carriers, down from 68 plans and 12 carriers in 2026; 10 plans are new, 17 are not returning, 13 are renamed, and 21 continuing plans change something in their terms. Plans reset their formularies (their list of covered drugs), pharmacy networks, and cost-sharing every year, so even if you love your plan, it's worth a look.

When comparing:

• Check that every medication you take is on the plan's 2027 formulary.
• Check the tier each drug lands on — that drives your copay.
• Confirm your preferred pharmacy is in-network. Mail-order can be different from retail.
• If you take a high-cost drug, ask whether the plan supports the Prescription Payment Plan and how enrollment works.

The Plan Finder tool at medicare.gov lets you enter your drugs and ZIP code and see how plans in your area compare on total estimated yearly cost.

A quick note on higher-income enrollees

If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may pay an IRMAA surcharge on top of your Part B and Part D premiums in 2026. Social Security will notify you if this applies. The $2,100 cap still protects you — it just doesn't apply to premiums.