Medicare Part D
Medicare Part D $2,100 Cap Arrives in Caldwell Jan 2026
CALDWELL, Idaho — Starting January 1, 2027, people with Medicare Part D will pay no more than $2,400 out of pocket for covered prescription drugs in a calendar year. The out-of-pocket cap, which began in 2025 at a lower amount, lands right as Caldwell residents sort through their choices during the Annual Enrollment Period, which runs through December 7.
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Speak to a Licensed Insurance Agent
Click to call 855-729-3240Key takeaways
- Starting January 1, 2027, Medicare Part D includes a $2,400 yearly cap on out-of-pocket drug costs, and once you hit it, covered drugs cost nothing more for the rest of the year.
- The old "donut hole" coverage gap is gone, leaving Part D with just three phases: deductible, initial coverage, and catastrophic.
- A new optional program called the Medicare Prescription Payment Plan (M3P) lets you spread high drug costs across the year instead of paying them all at once, though it doesn't lower your total costs.
- These federal rules, including the 2027 $2,400 cap and $700 deductible ceiling, apply to every Part D plan, but premiums, formularies, and pharmacy networks still vary, so comparing plans on medicare.gov's Plan Finder is worthwhile.
For anyone who has spent years bracing against high pharmacy bills, the cap — along with the end of the old "donut hole" and the option to spread payments across the year — is worth understanding before your 2027 coverage begins.
The 2027 out-of-pocket cap, in plain English
Under the rule, once your out-of-pocket spending on covered Part D drugs reaches $2,400 in 2027, you pay nothing more for the rest of that calendar year on drugs your plan covers. The cap resets each January. For reference, the cap is $2,100 in 2026.
A few things to keep in mind:
- The cap applies to covered Part D drugs. If a medication isn't on your plan's formulary, that spending generally doesn't count.
- Monthly premiums do not count toward the cap.
- The Part D deductible for 2027 is capped at $700, though many plans set it lower. (For 2026, the ceiling is $615.)
This cap is set by Medicare, not by any one insurance company, so it applies across all Part D plans — both stand-alone drug plans and the drug coverage built into most Medicare Advantage plans.
Goodbye, donut hole
For years, Part D had four phases, including the confusing "coverage gap" — the donut hole — where costs could jump unexpectedly midyear.
That gap was eliminated in 2025. In 2027, Part D has just three phases: the deductible phase, the initial coverage phase, and the catastrophic phase (where you pay nothing more once you hit the $2,400 cap).
For Caldwell seniors on multiple brand-name medications, this is the change that ends the old cycle of "my prescriptions cost more in the summer than in January."
The Medicare Prescription Payment Plan
Hitting the cap is good news at the end of the year, but $2,400 in January or February can still hurt. That's why Medicare offers the Medicare Prescription Payment Plan, sometimes called "M3P."
Here's how it works:
- You still have Part D coverage through your plan.
- Instead of paying the pharmacy directly for your share of drug costs, your plan bills you monthly.
- Your out-of-pocket costs are spread across the remaining months of the calendar year.
It doesn't lower your total costs, and it isn't right for everyone — especially people with low monthly drug bills. But if you have a high-cost medication early in the year, it can smooth out cash flow. Enrollment is free, voluntary, and handled through your Part D plan.
What this looks like in Caldwell
Caldwell is in Canyon County, where Medicare beneficiaries can choose from a range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. The exact number of plans available shifts each year as carriers file with CMS; the 2027 lineup is detailed in each plan's ANOC and on Medicare.gov's Plan Finder.
The 2027 $2,400 cap, the $700 deductible ceiling, and the payment plan option are federal rules, so they apply to every Part D plan sold in Canyon County — no matter which company runs it. What varies plan to plan are things like the formulary (which drugs are covered), pharmacy networks, and monthly premiums.
That's why comparing plans on medicare.gov's Plan Finder — using your actual medication list and preferred Caldwell-area pharmacies — matters more than reading generic ads.
A quick word on higher-income enrollees
If your 2024 income was above $109,000 (single filer) or $218,000 (joint), you'll pay an IRMAA surcharge on Part B and Part D premiums in 2026. IRMAA is set by the Social Security Administration based on your tax return from two years back. If your income has dropped because of a life event — retirement, loss of a spouse, divorce — you can ask SSA to reconsider using Form SSA-44.
Key dates to remember
- 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 $2,400 cap take effect.
- January 1 – March 31, 2027: Medicare Advantage Open Enrollment. If you're in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare.
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 Canyon County
(MA penetration in Canyon 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 as of 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
Q: Does the $2,100 cap include my insulin costs?
Q: What if I don't take many prescriptions — does any of this matter?
Q: 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.