Medicare Part D

Part D in Golden: 2027 Part D Cap Update

GOLDEN, Colo. — Starting Jan. 1, 2027, the Part D out-of-pocket ceiling adjusts for everyone with a Medicare Part D drug plan: no one will pay more than $2,400 out of pocket for covered prescriptions in a calendar year. It's the next step in a phased overhaul of how Medicare pays for drugs — and for people who take expensive medications, it remains one of the biggest changes in the program's history.

Here's what's changing for 2027, and what to do during the Annual Enrollment Period, which runs Oct. 15 through Dec. 7.

The $2,400 cap, in plain English

Once your out-of-pocket spending on covered Part D drugs reaches $2,400 in 2027, you pay $0 for the rest of the year on those drugs. That cap applies whether your Part D coverage comes through a standalone drug plan or is built into a Medicare Advantage plan.

A few things to know:

• The $2,400 counts what you pay — not what your plan pays.
• Premiums do not count toward the cap.
• Drugs must be covered by your plan's formulary for the spending to count.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027, though many plans set a lower one.

These are program-level rules set by CMS. What each plan charges for a specific drug can vary, so the way you actually hit that $2,100 in 2026 ($2,400 in 2027) depends on the plan you're in.

The coverage gap is officially history

For years, Part D had four phases, including the dreaded "donut hole" where costs jumped mid-year. That gap was eliminated as of 2025, and 2027 continues under the simpler three-phase design:

1. Deductible phase — you pay full negotiated cost until you meet your plan's deductible (no more than $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance while your plan pays the rest. 3. Catastrophic phase — once your out-of-pocket spending hits $2,400 in 2027, you pay nothing more for covered drugs the rest of the year.

That's it. No fourth phase, no confusing gap in the middle of the year.

The Medicare Prescription Payment Plan

Even with the $2,400 cap in 2027, some people hit big costs early in the year — think of a January refill on a specialty drug. To help with that, Medicare offers the Prescription Payment Plan (sometimes called "M3P" or drug-cost smoothing).

Here's how it works:

• It's optional and free to join.
• Instead of paying the pharmacy at pickup, you get a monthly bill from your Part D plan.
• Your total yearly cost is the same — it's just spread out across the calendar year.
• You can opt in before the plan year starts or any time during the year.

This won't help everyone. If your drug costs are low and steady, paying at the pharmacy is usually simpler. But for people facing a large early-year bill, it can prevent a cash crunch. You sign up through your Part D plan, not through Medicare directly.

What Golden residents should do during AEP

Golden is in Jefferson County, where Medicare plan availability — both standalone Part D and Medicare Advantage — is set at the county level. That means every Jefferson County resident sees the same menu of plans, whether you live near the School of Mines or up in the foothills. The 2027 plan lineup is detailed in each plan's ANOC and on Medicare.gov's Plan Finder.

A few practical steps before Dec. 7:

• Read your plan's Annual Notice of Change (ANOC). It arrives by late September and spells out what's changing in your plan for 2027.
• Check the formulary. Plans update which drugs they cover every year. A medication that was covered in 2026 may be handled differently in 2027.
• Use Plan Finder at medicare.gov. You can enter your exact drug list and pharmacy and see how each available plan would handle your costs.
• Watch your income. IRMAA surcharges on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026.

If you miss AEP, the Medicare Advantage Open Enrollment Period runs Jan. 1 through March 31 — but that window only lets you switch or drop an Advantage plan, not make every kind of change.