Medicare Part D
Schaumburg, IL: Medicare Part D Changes in 2027
SCHAUMBURG, Ill. — If you take prescription drugs and have Medicare, 2027 brings continued changes to Part D. There's a firm ceiling on what you pay out of pocket for covered drugs, a clearer three-phase structure, and a monthly payment option that can help smooth out big pharmacy bills. Here's a plain-language walk-through of how it all fits together.
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Will your prescriptions still be covered in 2027?
Part D plans rewrite their drug lists every year — tiers move, pharmacies change, drugs drop off. One call checks your exact medications against the 2027 plans in your area.
- Every prescription checked, name by name
- Your pharmacy checked for preferred pricing
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Speak to a Licensed Insurance Agent
Click to call 855-729-3240Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027.
- The Part D maximum deductible is $615 in 2026 and $700 in 2027, though some plans set it lower.
- The old "donut hole" is gone — Part D now has just three phases: deductible, initial coverage, and catastrophic.
- The Medicare Prescription Payment Plan lets you spread your drug costs across the year in monthly installments at no added charge.
The deductible phase: what you pay first
Part D starts with a deductible. The maximum allowed is $615 in 2026 and $700 in 2027, according to CMS. Some plans set it lower, and some waive it for certain drug tiers.
Until you meet the deductible, you generally pay the full negotiated price for your covered drugs at the pharmacy. Once you hit that amount, you move into the next phase.
One important note: the deductible only applies to drugs your plan covers. If a medication isn't on your plan's formulary (its drug list), what you pay for it usually doesn't count toward the deductible or the annual cap.
The initial coverage phase: sharing the cost
After the deductible, you and your plan share the cost of your covered drugs. You typically pay a copay (a flat dollar amount) or coinsurance (a percentage) for each prescription, and your plan pays the rest.
The exact amount depends on the drug's tier on your plan's formulary. Generic drugs usually cost the least; brand-name and specialty drugs cost more. Every dollar you pay out of pocket in this phase counts toward the annual cap.
The catastrophic phase: the annual cap kicks in
This is the big change that continues into 2027. Once your out-of-pocket spending on covered Part D drugs reaches the annual cap — $2,100 in 2026 and $2,400 in 2027 — you pay nothing more for the rest of the calendar year for any drug your plan covers. That's the catastrophic phase.
Before 2025, there was a "coverage gap" — the so-called donut hole — where people paid a larger share of drug costs after passing an initial limit. That gap has been eliminated. Part D now has just three phases: deductible, initial coverage, and catastrophic.
For people who take expensive brand-name or specialty medications, this cap can be the difference between a predictable year and a financially stressful one.
The Medicare Prescription Payment Plan
Even with the annual cap, hitting your out-of-pocket maximum in January or February can strain a household budget. That's where the Medicare Prescription Payment Plan comes in.
This is a free, optional program. Instead of paying the pharmacy directly when you fill a prescription, you can choose to have your plan bill you monthly, spreading your drug costs across the remaining months of the year. It doesn't lower your total costs — it just makes them more manageable month to month.
You can opt in through your Part D or Medicare Advantage plan with drug coverage. Medicare.gov has more details, and your plan is required to tell you about it.
Local context for Schaumburg
Schaumburg is in Cook County, where Medicare beneficiaries can generally choose between stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage. The specific plans available, their formularies, and their pharmacy networks vary — and they can change from year to year.
That's why fall matters. During the Annual Enrollment Period, October 15 through December 7, 2026, you can join, switch, or drop a Part D plan for 2027. If you have Medicare Advantage, the Medicare Advantage Open Enrollment Period runs January 1 through March 31 and lets you make one change.
A word on IRMAA
Most people pay only their plan's premium for Part D. But if your income is above certain thresholds, you'll pay an extra amount called the Income-Related Monthly Adjustment Amount, or IRMAA. In 2026, IRMAA surcharges for Part D begin above $109,000 in income for a single filer (higher thresholds apply for married couples filing jointly). Social Security bills this separately from your plan premium.
Common mistakes to avoid
A few missteps trip up people every year:
- Assuming every drug counts toward the cap. Only drugs covered by your plan's formulary count. Check your plan's drug list.
- Missing the enrollment window. Late Part D enrollment (without other creditable coverage) can trigger a lifelong penalty added to your premium.
- Not reviewing your plan each fall. Formularies, pharmacy networks, and costs can change. The plan that fit this year may not fit in 2027.
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 Cook County
(MA penetration in Cook 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). The hard yearly cap on what you pay out of pocket for covered drugs is $2,100 in 2026 and $2,400 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
What is the Part D out-of-pocket cap for 2027?
Is the donut hole really gone?
Do I have to pay the whole $2,100 in January if my drugs are expensive?
When can I change my Part D plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Also for Schaumburg
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This page was last updated: October 6, 2026.