Medicare Part D

Derby KS Part D 2027: $2,400 out-of-pocket cap

Derby, Kansas — Starting January 1, 2027, the way Medicare pays for prescription drugs continues to look different than it did just a couple of years ago. The headline change for next year: once you spend $2,400 out of pocket on covered Part D drugs in a calendar year, you pay nothing for the rest of the year. For Derby seniors who take costly medications, that ceiling is the story of this Annual Enrollment season.

What the $2,400 cap actually means

In 2025, Medicare capped Part D out-of-pocket drug spending at $2,000. The cap is $2,100 in 2026 and rises to $2,400 in 2027, according to CMS. Once your out-of-pocket spending on covered prescriptions reaches that amount in a plan year, you move into the catastrophic phase and pay nothing more for the rest of the year.

This is a real change from just a few years ago, when there was no annual limit at all. Before 2025, someone in Derby taking a specialty drug could easily spend well over $5,000 a year at the pharmacy. That ceiling is now closed.

Keep in mind: only what you pay for covered Part D drugs counts toward the cap. Premiums don't count. Drugs not on your plan's formulary don't count.

The coverage gap is officially gone

If you've been on Medicare for a while, you probably remember the "donut hole" — that middle stretch where you paid more out of pocket before catastrophic coverage kicked in. As of 2025, it's eliminated. Part D now has three phases instead of four:

1. Deductible phase — You pay the full negotiated price until you meet your plan's deductible (no more than $700 in 2027). 2. Initial coverage phase — You pay a copay or coinsurance; the plan pays the rest. 3. Catastrophic phase — Once your out-of-pocket costs hit $2,400 in 2027, you pay nothing for covered drugs.

That's it. No more confusing gap in the middle.

The Medicare Prescription Payment Plan

Here's a piece that hasn't gotten as much attention: even with the cap, $2,400 all at once — or several hundred dollars in a single January pharmacy visit — can be tough on a fixed income.

That's what the Medicare Prescription Payment Plan is for. It's a free, optional program that lets you spread your out-of-pocket Part D costs across the calendar year in monthly bills from your plan, instead of paying the pharmacy at pickup.

A few things to know:

• It doesn't lower your total drug costs — it just smooths them out.
• You have to opt in through your Part D or Medicare Advantage drug plan.
• It tends to help most if you have high drug costs early in the year.
• You can join anytime during the year, not just during AEP.

If your monthly budget is tight, ask your plan about signing up.

What Derby residents should do this fall

Derby is in Sedgwick County, where Medicare beneficiaries can compare Part D and Medicare Advantage drug plans during the Annual Enrollment Period, October 15 through December 7, 2026. For 2027, Sedgwick County has 24 Medicare Advantage plans from 6 carriers, with 5 new plans, 11 not returning, and 7 renamed. Any changes you make take effect January 1, 2027.

Because the Part D rules continue to shift, formularies, tiers, and pharmacy networks may look different from last year — even if you keep the same plan. It's worth pulling up your current drug list on the Medicare Plan Finder at medicare.gov and running it against 2027 plan options. If you do nothing and your current plan is offered next year, you keep it with the changes described in its Annual Notice of Change.

Also worth noting: higher-income beneficiaries pay an IRMAA surcharge on Part D and Part B. In 2026, IRMAA kicks in above $109,000 in modified adjusted gross income for a single filer (based on your 2024 tax return).

If you missed AEP or want to switch Medicare Advantage plans, the Medicare Advantage Open Enrollment Period runs January 1 through March 31.

Where to get unbiased help

You don't have to figure this out alone, and you don't have to talk to a salesperson to get answers. Free, unbiased help is available through:

• Medicare.gov — the official site, with the Plan Finder tool.
• 1-800-MEDICARE (1-800-633-4227) — 24/7 phone help.
• Kansas SHICK (Senior Health Insurance Counseling for Kansas) — the state's SHIP program, offering free one-on-one counseling for Derby and Sedgwick County residents.