Medicare Part D

Boise Medicare Part D: $2,100 Cap Begins January 2026

BOISE, Idaho — Medicare Part D's yearly out-of-pocket ceiling, new in 2026, continues in 2027 at a higher amount. The cap is $2,100 in 2026 and $2,400 in 2027. Once you reach it, you pay nothing more for covered medications for the rest of the calendar year.

For people in Boise and across Ada County who take expensive prescriptions, this is the biggest shift in Part D since the program began. Here's what's changing, what stayed, and the small mistakes that could still cost you.

The $2,100 cap, in plain language

The out-of-pocket cap applies to what you personally spend on covered Part D drugs — deductibles, copays, and coinsurance combined. Premiums don't count toward it. Drugs your plan doesn't cover don't count either.

Once your covered spending reaches the yearly cap — $2,100 in 2026 or $2,400 in 2027 — you move into what Medicare calls the "catastrophic" phase, and your share drops to $0 for the rest of the year. This is a program-wide rule set by CMS, so it applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan.

The "donut hole" is gone — really gone

For years, Part D had a confusing middle stage called the coverage gap, or "donut hole," where your costs could jump unexpectedly after your plan and you had spent a certain amount. That gap was eliminated in 2025.

In 2027, Part D still has just three phases:

• Deductible phase — you pay full negotiated price until you meet your plan's deductible (no plan can charge more than $615 in 2026 or $700 in 2027).
• Initial coverage phase — you pay a copay or coinsurance while your plan pays the rest.
• Catastrophic phase — after you reach the yearly out-of-pocket cap ($2,100 in 2026, $2,400 in 2027), you pay $0 for covered drugs.

No more surprise price jumps in the middle of the year. That alone is worth understanding before you compare coverage this fall.

The Medicare Prescription Payment Plan: help with cash flow

Even with a yearly cap, hitting that number early in the year — say, from one costly prescription in January — can strain a budget. That's where the Medicare Prescription Payment Plan comes in.

This is an optional program. If you opt in, you don't pay the pharmacy at pickup. Instead, your Part D plan bills you monthly, spreading your drug costs across the rest of the calendar year. Your total for the year doesn't change — it's the same money, just paid in smoother installments.

A few things to know:

• You must opt in through your Part D plan; it isn't automatic.
• It works best for people who face big pharmacy bills early in the year.
• If your drug costs are low and steady, it may not help much.
• You can join at any time during the year, but the earlier you enroll, the more months you have to spread payments over.

Call your plan directly to sign up, or ask about it during Annual Enrollment.

Mistakes to avoid this fall

The Annual Enrollment Period runs October 15 through December 7. A few common missteps trip people up every year:

1. Assuming your current plan is still the right fit. Formularies (the list of covered drugs), pharmacy networks, and cost-sharing tiers can change every year. Read your Annual Notice of Change. 2. Ignoring the payment plan option. If you skipped it in 2025 because you didn't need it, that could change if you start a new, higher-cost medication. 3. Forgetting about IRMAA. Higher-income beneficiaries pay an extra surcharge on Part B and Part D premiums. In 2026, IRMAA starts above $109,000 in income for a single filer. If your income has dropped due to retirement or a life event, you can appeal. 4. Missing the second window. The Medicare Advantage Open Enrollment Period runs January 1 through March 31, and it lets Medicare Advantage members switch plans or return to Original Medicare — but it's not a do-over for stand-alone Part D.

What Boise-area readers should do

Boise sits in Ada County, and county is where Medicare sets plan availability. For 2027, Ada County has 22 Medicare Advantage plans from 7 carriers to compare, with Saint Alphonsus Health Plan no longer offering plans in the county and St. Luke's Health Plan new to the county. The plan finder at medicare.gov lets you enter your ZIP code and your specific drugs to see estimated yearly costs under each plan — the single most useful step before you enroll.

If you'd rather talk to a human, Idaho's Senior Health Insurance Benefits Advisors (SHIBA) program is the state's official SHIP. Counselors are trained, unbiased, and free.