Medicare Part D
$2,100 Part D cap arrives Jan 1 for Waipahu Medicare
WAIPAHU, Hawaii — Starting January 1, 2027, the way Medicare pays for prescription drugs continues to look different than it did just a couple of years ago. A key figure: no one on a Medicare Part D plan will pay more than $2,400 out of pocket for covered prescriptions in a calendar year.
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Key takeaways
- Starting January 1, 2027, no one on a Medicare Part D plan will pay more than $2,400 out of pocket for covered prescriptions in a calendar year, and this cap applies to every Part D plan nationwide.
- The confusing "donut hole" coverage gap phase was eliminated in 2025 and stays gone in 2027, leaving three phases: deductible (up to $700 in 2027), initial coverage, and catastrophic (where you pay $0).
- To help spread out costs, Medicare offers an optional, free Medicare Prescription Payment Plan that lets you pay your Part D costs in monthly installments instead of all at once at the pharmacy.
- Higher earners should know that IRMAA, an income-based surcharge on Part B and Part D premiums, starts above $109,000 in income for a single filer in 2026, though most people won't reach that level.
That figure is set by Medicare itself and applies to every Part D plan in the country, whether the drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan. For people in Waipahu who take costly medications, it's the most significant shift in Part D since the program began.
Here's what's changing, what stayed, and how the new monthly payment option works.
The $2,100 cap, explained plainly
In 2027, once your out-of-pocket spending on covered Part D drugs reaches $2,400, you pay $0 for the rest of the year on those covered drugs. This cap is a Medicare rule — it isn't a plan perk or a promotion.
A few things to keep in mind:
- The cap counts what you pay out of pocket for covered drugs — deductibles and copays or coinsurance.
- Monthly premiums do not count toward the $2,100.
- Drugs that aren't on your plan's formulary (its covered list) generally don't count either.
- The maximum Part D deductible a plan can charge in 2026 is $615. Plans can set a lower deductible, but not a higher one.
The "donut hole" is gone
For years, the Part D "coverage gap" — the so-called donut hole — was the confusing middle stretch where costs jumped after you hit a spending threshold. That phase was eliminated in 2025, and it stays gone in 2027.
Part D now 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 until your out-of-pocket total reaches $2,400. 3. Catastrophic phase — you pay $0 for covered drugs the rest of the year.
That's it. No more donut hole math.
The Medicare Prescription Payment Plan
Here's the piece that hasn't gotten enough attention: even with a $2,100 cap, that money can hit hard if it lands in a single month — say, when you fill an expensive specialty medication in January.
To help with that, Medicare offers the Medicare Prescription Payment Plan. It's optional and free to join. Instead of paying the pharmacy at the counter, you get billed by your Part D plan in monthly installments spread across the rest of the year.
A few important notes:
- It doesn't lower your drug costs — it spreads them out.
- You can opt in before the year starts or at any point during the year.
- You have to be enrolled in a Part D plan (stand-alone or through Medicare Advantage) to use it.
- If you're already paying low monthly amounts, this program may not help much. It's designed for people facing large, uneven bills.
You can ask your plan to enroll you, or learn more at medicare.gov.
What this means for people in Waipahu
Waipahu is in Honolulu County, and Part D and Medicare Advantage plan choices are set at the county level. When Annual Enrollment opens each fall, Honolulu County residents can compare all the Part D and Medicare Advantage plans available in their area on the Medicare Plan Finder.
The $2,400 cap and the payment plan apply to every Part D plan, so the differences between plans in 2027 will mostly come down to premiums, formularies (which drugs are covered and at what tier), pharmacy networks, and deductibles up to $700.
Key dates to remember
- October 15 – December 7: Annual Enrollment Period. Changes take effect January 1.
- January 1 – March 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one chance to switch or return to Original Medicare.
Also worth knowing: IRMAA — the income-based surcharge some higher earners pay on top of Part B and Part D premiums — kicks in above $109,000 in income for a single filer in 2026. Most people don't hit that threshold, but if you do, it can affect your Part D costs.
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 Honolulu County
(MA penetration in Honolulu 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”) is eliminated as of 2025 (three phases now). There’s now a hard yearly cap of $2,100 on what you pay out of pocket for covered drugs, 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
Q: If I hit the $2,400 cap in July, do I really pay nothing for the rest of the year?
Q: Does the cap apply to Medicare Advantage plans with drug coverage?
Q: Do I have to sign up for the Prescription Payment Plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.