Medicare Part D
Medicare Part D in 2027: Drug Cap in Sioux City, IA
SIOUX CITY, Iowa — Starting Jan. 1, 2027, no one with a Medicare Part D drug plan will pay more than $2,400 out of pocket for covered prescriptions in a calendar year. That's the updated federal ceiling, and it continues the biggest change to how Medicare covers drugs in decades. If you take even one expensive medication, this fall is the time to understand how the numbers work — and to avoid a few common mistakes during the Annual Enrollment Period.
Compare Medicare options near you
Answer 3 quick questions to see Medicare Advantage, Medigap, and Part D listings from licensed insurance partners.
What’s your ZIP code?
Plan availability is set by your county, so we start here.
How old are you?
This helps match you with options you’re eligible for.
Do you have Medicare Parts A & B?
Most Medicare Advantage and Medigap options require both.
These listings are provided by licensed insurance partners.
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
Available now — current wait: 0 min
A real person answers. No phone menu, ever.
Want to see more plan options?
Answer a few more questions to continue to additional options from licensed partners.
Continue →Advertising disclosure: MyMedicarePlans.org may be compensated when you contact a partner or licensed agent. Listings are not ranked or endorsed by us, and we do not recommend specific plans. You can also contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.
Speak to a Licensed Insurance Agent
Click to call 855-729-3240Key takeaways
- Starting January 1, 2027, Medicare Part D out-of-pocket drug costs are capped at $2,400 per year, up from $2,100 in 2026.
- Once you hit that $2,400 cap, you pay nothing for the rest of the year on covered prescriptions.
- The optional, free Medicare Prescription Payment Plan lets you spread out-of-pocket drug costs into monthly bills instead of paying large amounts at the pharmacy early in the year, though you still owe the same total amount.
- The Annual Enrollment Period runs October 15 through December 7, 2026, and any plan changes you make take effect on January 1, 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 Woodbury County
(MA penetration in Woodbury 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.
What actually changed for 2027
The $2,000 out-of-pocket cap that took effect in 2025 is now $2,100 for 2026, adjusted by law each year. Once your out-of-pocket spending on covered Part D drugs reaches that amount, you pay $0 for the rest of the year on those covered prescriptions.
A few other 2027 numbers worth writing down:
- The maximum Part D deductible a plan can charge is $700 in 2027. Plans may charge less, but not more.
- The old "donut hole" coverage gap is gone. Part D now has just three phases: deductible, initial coverage, and catastrophic (where you hit the cap).
- IRMAA — the income-related surcharge on Part B and Part D premiums — kicks in above $109,000 for a single filer in 2026, based on your 2024 tax return.
These figures come from CMS and are the same everywhere in the country, including here in Sioux City.
The Medicare Prescription Payment Plan: know before you enroll
One of the least-understood changes is the Medicare Prescription Payment Plan — sometimes called "M3P" or drug cost smoothing. It's optional, and it's free to join.
Here's the idea: instead of paying the full cost of a prescription at the pharmacy counter (which can be hundreds of dollars in January if you have a big deductible), your Part D plan spreads your out-of-pocket drug costs across monthly bills for the rest of the plan year. You still owe the same total — up to the $2,400 ceiling in 2027 — but the timing is smoother.
Who benefits most? People with high drug costs early in the year. Who should think twice? People with low, steady drug spending — the monthly bills may feel like an extra hassle without much upside. You opt in through your Part D or Medicare Advantage plan, not through medicare.gov.
Sioux City sits in Woodbury County — and that matters
Medicare plan availability is set at the county level, not the city level. Sioux City is in Woodbury County, so when you shop on medicare.gov's Plan Finder, you'll enter your ZIP code and see the stand-alone Part D plans and Medicare Advantage plans available to Woodbury County residents. Neighbors just across the river in Nebraska or South Dakota will see a different list.
The Plan Finder shows you every available plan, its formulary (the list of drugs it covers), pharmacy network, and estimated yearly cost based on the medications you enter. It's the single most useful tool Medicare offers — and it's free.
Mistakes to avoid this fall
The Annual Enrollment Period runs Oct. 15 through Dec. 7, 2026. Changes you make take effect Jan. 1, 2027. A few pitfalls we see every year:
- Assuming your current plan is still your best fit. Plans change formularies, pharmacy networks, and pricing every year. Your Annual Notice of Change (ANOC), mailed in September, tells you what's different.
- Ignoring the formulary. A plan with a low premium doesn't help if it doesn't cover your drugs — or covers them at a high tier.
- Forgetting the pharmacy network. Preferred pharmacies often cost less than standard ones. Mail order isn't always cheaper — check.
- Confusing the two enrollment windows. Oct. 15–Dec. 7 is for everyone. The Medicare Advantage Open Enrollment Period (Jan. 1–March 31) only lets people already in a Medicare Advantage plan switch to another MA plan or return to Original Medicare.
What Star Ratings do and don't tell you
CMS publishes Star Ratings (1 to 5 stars) for Medicare Advantage and Part D plans based on things like customer service, member complaints, and drug safety measures. They're a useful data point, but they don't tell you whether a plan covers your specific medications or works with your doctor. Ratings are a starting point, not a decision.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) was eliminated as of 2025 (three phases now). There’s a hard yearly cap of $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 $2,400 cap include my monthly premium?
If I join the Prescription Payment Plan, do I still hit the $2,400 cap?
Do I have to sign up for the $2,400 cap?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.