Medicare Part D
Medicare's Part D Cap in Bloomington for 2027
BLOOMINGTON, Ind. — The Part D out-of-pocket cap that took effect January 1, 2026 at $2,100 rises to $2,400 on January 1, 2027. The yearly ceiling on what you pay for covered prescription drugs remains the biggest change to Medicare drug coverage in a generation, and Bloomington-area retirees are weighing their choices during Medicare's Annual Enrollment Period, which runs through December 7.
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Will your prescriptions still be covered in 2027?
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Key takeaways
- The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027, so once you hit that amount in a calendar year you pay nothing more for covered drugs the rest of the year.
- The old coverage gap phase is gone for good, leaving just three phases: deductible (up to a $615 maximum in 2026, rising to a $700 maximum in 2027), initial coverage (usually 25% cost share), and catastrophic (no cost after the yearly cap).
- The free, optional Medicare Prescription Payment Plan lets you split your drug costs into monthly installments instead of paying a big amount at the pharmacy, though you still owe the same total.
- Medicare's Annual Enrollment Period runs October 15 through December 7, and people already in a Medicare Advantage plan get another chance to switch once between January 1 and March 31.
Here's a plain-language look at what's new, what stayed, and where to get help.
The headline change: a hard $2,100 (2026; $2,400 in 2027) ceiling
The Part D out-of-pocket maximum is $2,100 in 2026 and $2,400 in 2027. Once your spending on covered drugs reaches that number, you pay nothing for the rest of the year on drugs your plan covers. This cap applies whether you have a stand-alone Part D plan or drug coverage built into a Medicare Advantage plan.
The cap was $2,000 in 2025 and is adjusted each year. It's a program-wide rule set by the Centers for Medicare & Medicaid Services (CMS), so it works the same way in Monroe County as it does anywhere else in the country.
The "donut hole" is gone
If you've been on Medicare for a while, you probably remember the coverage gap — the awkward middle stretch where your share of drug costs went up before catastrophic coverage kicked in. That phase was eliminated in 2025 and stays gone in 2027.
Part D now has just three phases:
1. Deductible phase — you pay full negotiated price until you meet your plan's deductible. The maximum deductible any plan can charge is $615 in 2026 and $700 in 2027, though many plans set it lower. 2. Initial coverage phase — you pay a share (usually 25%) of your covered drugs. 3. Catastrophic phase — once your out-of-pocket spending reaches the yearly cap, you pay nothing more for covered drugs the rest of the year.
That's it. No more gap in the middle to plan around.
The Medicare Prescription Payment Plan: spreading the cost out
The cap ($2,100 in 2026, $2,400 in 2027) is a yearly ceiling — but it doesn't prevent a big bill in a single month if you fill an expensive prescription early in the year. 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 installments instead of paying the pharmacy all at once. You still owe the same total amount, but the bills come from your plan monthly rather than from the pharmacy counter.
A few things to know:
- You have to opt in — it's not automatic.
- You can sign up before the plan year starts or at any point during the year.
- The pharmacy still runs your prescription; the plan then bills you.
- It tends to help most if you have high drug costs early in the year.
You can ask your Part D or Medicare Advantage plan directly about enrolling, or read the details at medicare.gov.
What this means during Annual Enrollment
Annual Enrollment runs October 15 through December 7 every year. This fall it's the window to compare Part D and Medicare Advantage plans for 2027 and switch if something fits better.
Bloomington is in Monroe County, and, as in most of Indiana, residents have a wide range of stand-alone Part D and Medicare Advantage plans available. Because formularies (the list of drugs each plan covers), pharmacy networks, and premiums differ from plan to plan, the smart move is to run your own prescriptions through the Plan Finder tool at medicare.gov to see how each plan would handle your specific drugs.
If you miss the December 7 deadline, there's also the Medicare Advantage Open Enrollment Period from January 1 through March 31, which lets people already in a Medicare Advantage plan switch once.
A quick word on higher-income surcharges (IRMAA)
Most people pay the standard Part B and Part D premiums. But if your income is above certain thresholds, you'll pay an Income-Related Monthly Adjustment Amount (IRMAA) on top. For 2026, IRMAA begins for single filers with income above $109,000 (and the equivalent married thresholds). Social Security bases this on your tax return from two years earlier.
The out-of-pocket cap ($2,100 in 2026, $2,400 in 2027) still applies to you regardless of IRMAA — the surcharge is a premium add-on, not an out-of-pocket drug cost.
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 Monroe County
(MA penetration in Monroe 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”) 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
Does the $2,100 cap include my monthly Part D premium?
What if my drug isn't on my plan's formulary?
Do I have to sign up for the payment plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.