Medicare Part D
Boise Medicare: Part D Cap & Coverage Gap 2027
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. The out-of-pocket cap rises from $2,100 in 2026, and the change lands in the middle of Medicare's Annual Enrollment Period, which runs through December 7.
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Key takeaways
- Starting January 1, 2027, Medicare Part D out-of-pocket drug costs are capped at $2,400 per calendar year, after which covered drugs cost nothing more for the rest of the year.
- The old Part D "donut hole" coverage gap was eliminated in 2025, leaving just three phases: deductible, initial coverage, and catastrophic.
- In 2027, the Part D deductible can be no more than $700, and the optional Medicare Prescription Payment Plan lets people spread out-of-pocket drug costs into monthly bills instead of paying large amounts at the pharmacy.
- These rules apply nationwide, but plan premiums, drug formularies, and pharmacy networks vary by plan, so comparing options during Medicare's Annual Enrollment Period, which runs through December 7, is important.
Boise, Idaho — The out-of-pocket drug cap rises in 2027
For Boise readers weighing their drug coverage this fall, the updated cap is worth understanding before you lock in a plan for next year. Here is a plain-language look at what changed, what stayed the same, and where to get help.
What the Part D cap actually covers
The limit ($2,100 in 2026, $2,400 in 2027) applies to what you spend out of pocket on covered Part D drugs — that includes your deductible and any copays or coinsurance for prescriptions your plan covers. Once your out-of-pocket spending hits $2,100 in 2026 ($2,400 in 2027) during the year, you pay $0 for your covered drugs for the rest of the calendar year.
A few things the cap does not cover:
- Your monthly Part D premium
- Drugs your plan does not cover (non-formulary drugs)
- Over-the-counter medications
- Drugs paid for under Part B (like many drugs given in a doctor's office)
The cap resets each January 1.
The "donut hole" is gone
If you have been on Medicare for a while, you probably remember the coverage gap, often called the "donut hole." That was the confusing middle stretch where your drug costs could suddenly jump.
The coverage gap was eliminated in 2025. Part D now has just three phases:
1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (no more than $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance for each drug. 3. Catastrophic phase — once your out-of-pocket spending reaches $2,400, you pay nothing more for covered drugs that year.
Simpler math, and a hard stop on how high your yearly drug bill can go.
The Medicare Prescription Payment Plan: spreading costs out
Even with a $2,100 in 2026 ($2,400 in 2027) ceiling, hitting that number in January or February can be painful if you take an expensive medication. That is what the Medicare Prescription Payment Plan is for.
This is a free, optional program built into every Part D plan. Instead of paying a large amount at the pharmacy counter, you can choose to spread your out-of-pocket drug costs across the remaining months of the year in monthly bills from your plan.
A few key points:
- It does not lower your total cost — it just smooths out when you pay.
- You can sign up before the plan year starts or at any point during the year.
- If you miss payments, you can be removed from the program, though you keep your drug coverage.
If you take a high-cost specialty drug, this option is worth asking your plan about.
What Boise-area readers should keep in mind
Boise sits in Ada County, and Medicare drug plan availability — including stand-alone Part D plans and Medicare Advantage plans that include drug coverage — is set at the county level. Ada County residents have a broad menu of plans to compare during Annual Enrollment.
The rules above (the cap ($2,100 in 2026, $2,400 in 2027), the $615 maximum deductible, the payment plan option) apply the same way whether you live in Boise, Meridian, Nampa, or anywhere else in the country. What varies from plan to plan is the monthly premium, the drug formulary, and the pharmacy network — which is why comparing coverage each fall matters.
Also worth noting: IRMAA (the income-related surcharge for higher earners) kicks in above $109,000 in modified adjusted gross income for a single filer in 2026. That surcharge is added to both Part B and Part D premiums.
Key dates for this fall and next spring
- October 15 – December 7, 2026: Annual Enrollment Period. Change your Part D or Medicare Advantage plan for 2027.
- January 1, 2027: New coverage — and the new $2,400 cap — take effect.
- January 1 – March 31, 2027: Medicare Advantage Open Enrollment. If you are in a Medicare Advantage plan, you get one chance to switch to another MA plan or drop back to Original Medicare with a stand-alone Part D plan.
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 Ada County
(MA penetration in Ada 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 in 2026 ($2,400 in 2027) 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
Does the $2,100 cap include my monthly Part D premium?
If I already hit a high out-of-pocket amount in 2025, does that roll over?
Do I have to sign up for the Medicare Prescription Payment Plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.