Medicare Part D
Part D Coverage Gap Ends for Naperville Residents
NAPERVILLE, Ill. — Starting January 1, 2027, people with Medicare Part D drug coverage will not pay more than $2,400 out of pocket for their covered prescriptions in a calendar year. It's one of the biggest shifts to Medicare in years, and it lands right as Naperville-area seniors are finishing up their choices during the fall Annual Enrollment Period (October 15 – December 7).
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Key takeaways
- Starting January 1, 2027, people with Medicare Part D coverage won't pay more than $2,400 out of pocket for covered prescriptions in a year, and costs drop to nothing once that cap is reached.
- The old "donut hole" coverage gap was eliminated in 2025, leaving Part D with three phases: deductible, initial coverage, and catastrophic.
- The Part D maximum deductible is $615 in 2026 and $700 in 2027 before initial coverage begins.
- A free, optional Medicare Prescription Payment Plan lets people spread their out-of-pocket drug costs into monthly payments through their plan instead of paying all at once at the pharmacy.
Big Relief for Naperville Seniors on Prescription Drugs
The new cap builds on a change that took effect in 2025, when the old "donut hole" — the confusing coverage gap that used to sit between regular coverage and catastrophic coverage — was eliminated. Together, these updates are meant to make drug costs more predictable, especially for people who take expensive medications.
Here's what to know.
How the $2,100 Out-of-Pocket Cap Works
Under the 2026 rules from the Centers for Medicare & Medicaid Services (CMS), once your out-of-pocket spending on covered Part D drugs hits $2,100, you pay $0 for the rest of the year on those covered prescriptions.
A few important points:
- The cap applies to what you pay — deductibles and copays for covered drugs count toward it. Monthly premiums do not count.
- The maximum Part D deductible in 2026 is $615, though individual plans can set a lower deductible.
- The cap applies to Part D drugs, whether you get that coverage through a stand-alone Part D plan or through a Medicare Advantage plan that includes drug coverage.
- Drugs not covered by your plan's formulary generally don't count toward the cap.
For someone in Naperville who takes several brand-name medications, the difference between hitting the yearly cap and stopping — versus the old system where costs could keep climbing — can be substantial.
The Coverage Gap Is Gone
If you remember the "donut hole," you can officially forget it. Since 2025, Part D has had three phases instead of four:
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 while your plan pays the rest. 3. Catastrophic phase — once your out-of-pocket costs reach $2,400 in 2027, you pay nothing more for covered drugs that year.
That's it. No more surprise jump in costs partway through the year.
The Medicare Prescription Payment Plan: Spreading Costs Over the Year
Even with the yearly cap, hitting it in January or February can still sting if you take costly medications. That's where the Medicare Prescription Payment Plan comes in.
This is a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly payments, instead of paying the pharmacy all at once. You still owe the same total, but the bill arrives from your plan on a monthly basis.
A few things to know:
- You must opt in — it isn't automatic. You can enroll before the plan year starts or any time during the year.
- It works best for people with high or uneven drug costs. If your prescriptions are inexpensive, it may not help much.
- Missing payments could affect your enrollment, so it's worth understanding the terms before signing up.
Your Part D or Medicare Advantage plan has to offer this option, and information about how to enroll comes directly from your plan.
What Naperville Residents Should Do This Fall
Naperville sits in DuPage County, where Medicare beneficiaries have a range of stand-alone Part D and Medicare Advantage plans to compare each year. Plan availability, formularies, pharmacy networks, and costs are set at the county level and can change from one year to the next.
A few practical steps during Annual Enrollment (through December 7):
- Read your Annual Notice of Change (ANOC) from your current plan. It shows what's changing for 2027.
- Check your drugs against the 2027 formulary — a medication that was covered in 2026 might move tiers or require prior authorization.
- Compare plans on the official Medicare Plan Finder at medicare.gov.
- If you miss the fall window, the Medicare Advantage Open Enrollment Period runs January 1 – March 31 for people already on a Medicare Advantage plan.
A Note on Higher-Income Households
If your income is above $109,000 (single filer, based on 2024 tax return data for 2026), you may pay an IRMAA surcharge on top of your standard Part B and Part D premiums. The Social Security Administration notifies you if this applies. IRMAA doesn't change the $2,100 cap — it just changes what you pay in premiums.
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.
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
Q: Do I have to sign up for the new $2,100 cap?
Q: Does the $2,100 include what I spend on over-the-counter drugs or vitamins?
Q: Do I need to opt in to the Medicare Prescription Payment Plan every year?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.