Medicare Part D

Part D coverage gap & Evansville, IN (2027)

EVANSVILLE, Ind. — Since January 1, 2026, the way Medicare pays for prescription drugs has changed in a big way. For the first time, there is a firm yearly limit on what people with Medicare Part D pay out of pocket for their medicines. That cap was $2,100 in 2026 and is $2,400 in 2027. Once you hit that number, you pay $0 for the rest of the calendar year on covered drugs.

For older adults in Evansville — especially anyone managing diabetes, heart conditions, cancer, or another illness that leans on expensive prescriptions — this is one of the most meaningful Medicare changes in years.

Here's what's actually shifting, and how it lands locally.

The Part D cap, in plain English

Medicare set the Part D out-of-pocket cap at $2,000 in 2025 and $2,100 in 2026. For 2027, that cap is $2,400, based on annual adjustments set by the Centers for Medicare & Medicaid Services (CMS).

A few things worth knowing:

• The cap applies to covered Part D drugs — prescriptions on your plan's formulary.
• It counts what you pay: deductibles, copays, and coinsurance at the pharmacy.
• Monthly plan premiums do not count toward the cap.
• The Part D deductible can be no higher than $615 in 2026.

Once your out-of-pocket spending on covered drugs hits the yearly cap, you're done paying at the pharmacy counter for those drugs until January.

The "donut hole" is gone

For years, Medicare's coverage gap — the so-called "donut hole" — was the part of the year when people suddenly paid a lot more for their prescriptions after hitting a spending threshold. It confused a lot of people, and it hurt.

That phase was eliminated in 2025, and it stays gone in 2027. Part D now has three straightforward phases:

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 for each prescription. 3. Catastrophic phase — once you hit the yearly out-of-pocket cap ($2,400 in 2027), you pay nothing more for covered drugs the rest of the year.

No more surprise price jump in the middle of the year.

The Medicare Prescription Payment Plan

Here's the piece a lot of Evansville readers have been asking about. Even with the yearly cap, some people hit big costs early in the year — think a large bill in January for a specialty drug. That's tough on a fixed income.

The Medicare Prescription Payment Plan lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying it all at the pharmacy. It's optional and free to join.

A few key points:

• You still owe the same total amount — it's just spread out.
• You sign up through your Part D or Medicare Advantage plan with drug coverage, not at the pharmacy.
• It tends to help most if you have high drug costs early in the year.
• If your drug costs are low or steady, it may not change much for you.

You can learn more or start the process at medicare.gov or by calling your plan directly.

What this looks like in Vanderburgh County

Evansville is in Vanderburgh County, where Medicare plan availability — including stand-alone Part D drug plans and Medicare Advantage plans that include drug coverage — is set at the county level by CMS. That means every Evansville resident chooses from the same menu of plans as their neighbors across the county.

The cap ($2,100 in 2026, $2,400 in 2027) and the payment plan option apply to all Part D coverage, whether you get it through a stand-alone drug plan added to Original Medicare or through a Medicare Advantage plan that includes prescriptions. This isn't a benefit tied to any one carrier — it's a program-wide change.

If you'd like a walk-through in person, Indiana's State Health Insurance Assistance Program (SHIP) offers free, unbiased Medicare counseling to Vanderburgh County residents.

Dates to circle

• October 15 – December 7, 2026: Medicare Annual Enrollment Period. This is when most people can join, switch, or drop a Part D or Medicare Advantage plan for 2027.
• January 1, 2027: The updated $2,400 Part D out-of-pocket cap takes effect.
• January 1 – March 31, 2027: Medicare Advantage Open Enrollment Period. If you're in a Medicare Advantage plan, you get one chance to switch to another Medicare Advantage plan or return to Original Medicare with a Part D plan.

One more figure worth knowing: IRMAA — the income-related surcharge that raises Part B and Part D premiums for higher earners — kicks in above $109,000 in income for a single filer in 2026 (higher for couples). Most people don't pay it, but if your income has changed, it's worth checking.