Medicare Part D
$2,400 Part D cap & Sandy Springs drug costs 2027
SANDY SPRINGS, Ga. — If you take prescription medications and rely on Medicare, 2027 brings another meaningful update to Part D. A higher out-of-pocket cap, a simpler phase structure, and an optional monthly payment plan continue to reshape how you'll pay for drugs at the pharmacy counter.
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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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Key takeaways
- Starting in 2027, Part D out-of-pocket costs are capped at $2,400 per year, and after that you pay nothing for covered drugs.
- Plan deductibles can't be higher than $700 in 2027, though some plans charge less or nothing.
- The old coverage gap, or "donut hole," is gone, leaving just three phases: deductible, initial coverage, and catastrophic.
- An optional, free Medicare Prescription Payment Plan lets you spread drug costs into monthly payments instead of paying it all at the pharmacy.
A clearer look at Part D for Sandy Springs readers
Here's a plain-language walk-through of how Part D works in 2027 — the deductible, the cap, and the three phases — so you can make sense of your coverage before the next pharmacy trip.
The Part D out-of-pocket cap
Starting in 2027, no one with a Medicare Part D plan will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year. Once you hit that limit, you pay nothing for covered medications for the rest of the year.
This cap applies whether your Part D coverage comes through a stand-alone drug plan or through a Medicare Advantage plan that includes drug coverage. It's a program-wide rule set by Medicare, not a plan-by-plan perk.
The deductible: up to $700
Each Part D plan can set its own deductible, but Medicare caps that amount at $700 for 2027. Some plans use the full amount, some use a smaller deductible, and some don't charge one at all for certain drug tiers.
During the deductible phase, you generally pay the full negotiated price of your medications until you've met that plan's deductible.
The three phases of Part D in 2027
The old "donut hole" coverage gap was eliminated in 2025. That means Part D now has just three phases instead of four:
1. Deductible phase. You pay the full cost of your covered drugs until you meet your plan's deductible (up to $700).
2. Initial coverage phase. After the deductible, you pay a copay or coinsurance for each prescription, and your plan pays the rest. You stay here until your out-of-pocket spending reaches $2,400.
3. Catastrophic phase. Once you hit the $2,400 cap, you pay nothing for covered drugs for the rest of the calendar year.
That's it. No more confusing gap in the middle of the year where costs suddenly jumped.
The Medicare Prescription Payment Plan
If your medications are expensive early in the year, the Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across monthly payments instead of paying big amounts at the pharmacy counter. It doesn't lower your total cost — it just smooths it out over the calendar year.
Enrollment is optional and free. You sign up through your Part D plan. For some people, especially those with high-cost specialty drugs, it can make budgeting much easier.
What this looks like in Sandy Springs
Sandy Springs is in Fulton County, where Medicare beneficiaries can choose from a wide range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. For 2027, Fulton County has 81 Medicare Advantage plans from 10 carriers. Plan availability, formularies (the list of covered drugs), pharmacy networks, and premiums vary — but the $2,400 cap, the $700 maximum deductible, and the three-phase structure are the same nationwide.
If your income is above $109,000 as a single filer (or $218,000 for joint filers) in 2026, you may also pay an IRMAA surcharge on top of your Part D premium. That's based on your tax return from two years earlier.
Key dates to remember
- Annual Enrollment Period: October 15 – December 7. This is when you can join, switch, or drop a Part D or Medicare Advantage plan for the following year.
- Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in a Medicare Advantage plan, you can make a one-time change during this window.
Even if you're happy with your current coverage, it's worth reviewing your plan each fall. Formularies and pharmacy networks can change from year to year.
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 Fulton County
(MA penetration in Fulton 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.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) was eliminated in 2025 (three phases now). There's a hard yearly cap of $2,400 on what you pay out of pocket for covered drugs 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
Do I automatically get the $2,100 cap, or do I have to sign up for something?
Does the cap include my monthly premium?
What if my medication isn't on my plan's formulary?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.