Medicare Part D
Denver Part D: 2027 Cap and Payment Plan
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 the federal cap, and it applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan.
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Will your prescriptions still be covered in 2027?
Part D plans rewrite their drug lists every year — tiers move, pharmacies change, drugs drop off. One call checks your exact medications against the 2027 plans in your area.
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Click to call 855-729-3240Key takeaways
- Starting January 1, 2027, Medicare Part D has a $2,400 yearly cap on out-of-pocket drug costs, and once you hit it, covered drugs cost nothing for the rest of the year.
- The old "donut hole" coverage gap is gone, leaving three simple phases: a deductible phase (up to $700 in 2027), an initial coverage phase with copays or coinsurance, and a catastrophic phase with no cost.
- The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs into monthly installments instead of paying it all at once.
- IRMAA surcharges on Part B and Part D premiums start above $109,000 in income for single filers in 2026, but you can ask Social Security to reconsider if your income has recently changed.
Denver, CO — A real ceiling on drug costs starts Jan. 1
For Denver readers comparing coverage during this fall's Annual Enrollment Period (October 15 – December 7), the cap is the single biggest change to understand. It reshapes how you should think about the trade-off between monthly premiums and the risk of a very expensive year.
What the Part D cap actually covers
The cap applies to your out-of-pocket spending on covered Part D drugs — the medications on your plan's formulary, bought at a pharmacy in your plan's network. Once your true out-of-pocket costs hit $2,400, you pay nothing for covered drugs for the rest of the year.
A few things the cap does not do:
- It does not cover monthly plan premiums.
- It does not cover drugs your plan doesn't list on its formulary.
- It does not apply to Part B drugs (those given in a clinic, like most infusions).
The Part D maximum deductible for 2027 is $700. Individual plans can set a lower deductible, but no plan can set a higher one.
The "donut hole" is gone — here's the structure now
If you or a family member remembers the old coverage gap (nicknamed the donut hole), that phase was eliminated in 2025 and remains gone in 2027. Part D now has three simple phases:
1. Deductible phase — you pay full negotiated price until you meet the plan's deductible (up to $700). 2. Initial coverage phase — you pay a copay or coinsurance for each prescription. 3. Catastrophic phase — once your out-of-pocket spending reaches $2,400, you pay nothing for covered drugs for the rest of the year.
This is a cleaner design than Medicare has had in nearly 20 years, and it makes annual costs far easier to predict.
The Medicare Prescription Payment Plan: spreading costs across the year
Hitting the cap in January doesn't mean you owe $2,100 in 2026 ($2,400 in 2027) in January. Under the Medicare Prescription Payment Plan, you can ask your Part D plan to spread your out-of-pocket drug costs across the calendar year in monthly installments.
A few things to know:
- It's optional and free to opt into — there's no fee or interest.
- It doesn't lower your total drug costs; it just smooths them out.
- It tends to help most people who face a big pharmacy bill early in the year.
- You sign up through your Part D plan, not through Medicare directly.
If your prescriptions are inexpensive and steady, the payment plan may not be worth the paperwork. If one of your drugs carries a large upfront cost, it can prevent a rough January.
How Denver residents can decide during AEP
Denver is in Denver County, where Part D and Medicare Advantage plan availability is set at the county level by CMS. The specific plans, formularies, and pharmacy networks available to you depend on your ZIP code and county, not the city name alone.
Here's a practical way to think through your choice this fall:
- List your drugs, doses, and pharmacies. This is the single most useful thing you can do before comparing anything.
- Use the Plan Finder at medicare.gov. Enter your medications, and it will estimate your total yearly cost — premiums plus drug costs — under each plan available in Denver County.
- Check the formulary, not just the premium. A low-premium plan that doesn't cover your medication may cost more overall.
- Confirm your pharmacy is in-network. Preferred pharmacies often carry lower cost-sharing.
- Think about the payment plan. If any of your drugs has a high sticker price, ask whether the monthly smoothing option would help.
One more note on income: IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for single filers in 2026 (higher for joint filers). If your income has changed recently — say, from retirement or a life event — you can ask Social Security to reconsider.
Key dates to keep in mind
- October 15 – December 7: Annual Enrollment Period. Change your Part D or Medicare Advantage plan for 2027.
- January 1, 2027: New coverage begins; the $2,400 cap takes effect.
- January 1 – March 31: Medicare Advantage Open Enrollment Period, when Advantage enrollees can switch plans once 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 Denver County
(MA penetration in Denver 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.
Key dates
Medicare enrollment periods at a glance
- Around your 65thInitial Enrollment PeriodA 7-month window around the month you turn 65 — your first chance to sign up.
- October 15 – December 7Annual Enrollment PeriodAnyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan.
- January 1 – March 31Medicare Advantage Open EnrollmentIf you're already in a Medicare Advantage plan, you can make one change.
- January 1 – March 31General Enrollment PeriodFor people who missed their first chance to sign up for Part B.
- VariesSpecial Enrollment PeriodTriggered by life events like moving or losing other coverage.
Dates are set by Medicare and apply nationwide. Confirm your personal windows at Medicare.gov or 1-800-MEDICARE.
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 $2,100 cap reset every year?
If I already take expensive drugs, will I hit the cap fast?
I have a Medicare Advantage plan with drug coverage. Does the cap apply to me?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.