Medicare Part D

Medicare Part D in Waukegan, Ill. — 2027

Waukegan, Ill. — On January 1, 2027, the Part D out-of-pocket cap rises to $2,400, up from $2,100 in 2026. For seniors in Waukegan who juggle high-cost medications, this is the figure to understand before the Annual Enrollment Period closes on December 7.

Here's a plain-language look at what's different, what it means locally, and how to think through your choices this fall.

The Part D Cap, in Plain English

Medicare Part D now has a true ceiling on what you pay for prescription drugs each year. Once your out-of-pocket spending on covered drugs hits $2,100 in 2026, you pay $0 for the rest of the year on those covered prescriptions.

A few important details from CMS:

• The cap applies to covered Part D drugs — medications on your plan's formulary.
• Premiums do not count toward the cap.
• The cap resets every January 1.
• The Part D maximum deductible is $615 for 2026 and $700 for 2027, though many plans set theirs lower.

If you take even one specialty or brand-name drug, you could hit the cap early in the year and then pay nothing more for covered prescriptions until January.

The "Donut Hole" Is Gone

For years, Part D had a confusing middle stage called the coverage gap, or "donut hole," where costs could jump unexpectedly. That phase was eliminated in 2025, and Part D now has just three straightforward stages:

1. Deductible — you pay the full negotiated price until you meet your plan's deductible (up to $615 in 2026 and $700 in 2027). 2. Initial coverage — you pay a copay or coinsurance, and your plan pays the rest. 3. Catastrophic coverage — once your out-of-pocket total reaches the annual cap ($2,100 in 2026, $2,400 in 2027), you pay nothing more for covered drugs.

No more surprise price hike halfway through the year. That alone makes budgeting easier for people on fixed incomes.

The Medicare Prescription Payment Plan

Even with the annual cap, hitting that number in January or February can hurt if it all lands in one pharmacy trip. That's where the Medicare Prescription Payment Plan comes in.

This is a free, optional program that lets you spread your Part D out-of-pocket costs across the calendar year in monthly bills instead of paying the pharmacy at pickup. You still owe the same total — nothing is forgiven — but the payments are smoothed out.

Who tends to benefit most:

• People with one or more high-cost drugs early in the year.
• People who would rather budget a predictable monthly amount than face a large single bill.

Who may not need it:

• People whose prescriptions are inexpensive and spread evenly through the year.

You can opt in through your Part D or Medicare Advantage drug plan. Ask your plan directly, or call 1-800-MEDICARE.

What This Means in Waukegan and Lake County

Waukegan is in Lake County, Illinois, and Medicare plan availability is set at the county level. Every stand-alone Part D plan and every Medicare Advantage plan with drug coverage sold in Lake County must follow the federal cap and three-phase structure — a federal rule, not a plan feature. For the 2027 lineup, check each plan's Annual Notice of Change and Medicare.gov's Plan Finder.

That means when you compare plans during the Annual Enrollment Period (October 15 – December 7), the cap itself isn't a point of difference. What still varies plan to plan:

• Which drugs are on the formulary.
• What tier your specific medications fall into.
• Pharmacy networks (including which Waukegan-area pharmacies are preferred).
• Monthly premium.
• Deductible amount (up to the federal maximum — $615 in 2026, $700 in 2027).

If you're already in a Medicare Advantage plan and want to switch, you also get the Medicare Advantage Open Enrollment Period from January 1 through March 31.

How to Decide What to Do This Fall

A simple, honest checklist:

1. List your medications — names, doses, and how often you take them. 2. Run the Plan Finder at medicare.gov, which will estimate your total yearly drug costs under each plan available in Lake County. 3. Check your pharmacy — the same drug can cost different amounts at different pharmacies within the same plan. 4. Think about cash flow — if you'd hit the cap ($2,100 in 2026, $2,400 in 2027) fast, ask about the Prescription Payment Plan. 5. Check your income — Part D IRMAA surcharges kick in above $109,000 for a single filer in 2026 ($218,000 for joint filers).

For free, unbiased, one-on-one help, Illinois has a State Health Insurance Assistance Program (SHIP) — locally called Illinois SHIP — with counselors who don't sell plans.