Medicare Part D

How the 2026 Medicare drug cap works for Idaho Falls

IDAHO FALLS, Idaho — The firm yearly limit on what you pay out of pocket for covered Part D drugs continues in 2027. Once your covered Part D costs reach $2,400 for the year, you pay $0 for the rest of 2027. For folks in Idaho Falls who have watched drug bills climb, this cap is one of the biggest Medicare changes in years — and it's worth understanding before the Annual Enrollment Period ends Dec. 7.

What's changing in 2027

Medicare's prescription drug program (Part D) completed a multi-year overhaul under the Inflation Reduction Act. Two figures matter most for 2027:

• A $2,400 annual out-of-pocket cap on covered Part D drugs in 2027 (up from $2,100 in 2026). This applies whether you have a stand-alone Part D plan or drug coverage built into a Medicare Advantage plan.
• A maximum deductible of $700 in 2027 (up from $615 in 2026). Plans can charge less, but not more.

The cap applies only to what you pay for covered drugs at in-network pharmacies. Premiums don't count toward it, and neither do drugs your plan doesn't cover.

The "donut hole" is really gone

For years, Idaho Falls retirees dreaded the coverage gap — that awkward middle stretch where costs jumped once total drug spending crossed a threshold. The coverage gap was eliminated in 2025, and Part D now has just three phases:

1. Deductible phase — you pay full negotiated price until you meet the plan's deductible (no more than $700 in 2027). 2. Initial coverage phase — you pay copays or coinsurance until your out-of-pocket total reaches $2,400 in 2027. 3. Catastrophic phase — you pay nothing more for covered drugs for the rest of the year.

That's it. No more "donut hole" math.

The Medicare Prescription Payment Plan

Hitting $2,400 in January doesn't feel great if your fixed income is spread across 12 months. That's why Medicare offers the Medicare Prescription Payment Plan — a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying the pharmacy all at once.

A few things to know:

• It doesn't lower your total drug costs — it just smooths them out.
• You can opt in before the plan year starts or any month during the year.
• Your Part D plan (not the pharmacy) bills you directly each month.
• It tends to help most if you have expensive medications early in the year.

You sign up through your drug plan, not through Medicare directly.

What this means locally

Idaho Falls sits in Bonneville County, and like the rest of Idaho, residents here choose Part D coverage either through a stand-alone drug plan paired with Original Medicare or through a Medicare Advantage plan that includes drug coverage. The 2027 cap and payment plan rules apply the same way in every county — but the specific plans available, their formularies (the list of covered drugs), and their pharmacy networks vary by county. The 2027 lineup is in each plan's ANOC and on Medicare.gov's Plan Finder.

That's why it's worth checking your own plan's 2027 Annual Notice of Change, which arrived by mail in late September. It spells out what's different next year for your plan — including whether your medications are still on the formulary.

Deadlines to circle

• Oct. 15 – Dec. 7, 2026: Medicare Annual Enrollment Period. Switch, join, or drop Part D and Medicare Advantage plans for 2027.
• Jan. 1 – March 31, 2027: Medicare Advantage Open Enrollment. If you're already in an Advantage plan, you get one chance to switch to another or return to Original Medicare with a stand-alone drug plan.

One more note: income-related surcharges (IRMAA) on Part B and Part D premiums begin above $109,000 in income for a single filer in 2026. Most people don't pay them, but higher earners should plan for them.