Medicare Part D

How Medicare Part D Changes in 2027 Reach Gardner

Gardner, Kansas — Starting January 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. It's a continuation of the biggest change to Medicare drug coverage in nearly two decades, and it's landing right in the middle of Annual Enrollment, which runs through December 7.

If you've ever stared at a pharmacy receipt and wondered when the bills would stop, this is the year the answer finally has a number attached.

What the Part D cap actually does

The cap is a hard ceiling. Once your out-of-pocket spending on covered Part D drugs hits $2,400 in 2027, you pay $0 for the rest of the year on those covered prescriptions. That's true whether you have a stand-alone Part D plan or drug coverage bundled into a Medicare Advantage plan.

A few things to know about how the cap works:

• Only what you pay counts toward the cap — not what your plan pays.
• Premiums do not count toward the $2,100 in 2026 ($2,400 in 2027).
• The cap applies to drugs on your plan's formulary (its covered list). Drugs the plan doesn't cover don't count.
• The maximum Part D deductible for 2027 is $700, though many plans set theirs lower.

The "donut hole" is gone — for good

For years, Medicare drug coverage had four confusing phases, including the dreaded coverage gap, or "donut hole," where costs jumped in the middle of the year. That gap was eliminated in 2025 and stays gone in 2027.

Part D now has just three phases:

1. Deductible — you pay full negotiated cost until you meet your plan's deductible (up to $700 in 2027). 2. Initial coverage — you pay a share (usually 25%) until your out-of-pocket total hits $2,400. 3. Catastrophic coverage — you pay $0 for covered drugs the rest of the year.

Simpler math, and a clear finish line.

The Medicare Prescription Payment Plan: spreading the cost

Here's the piece a lot of Gardner-area readers are asking about. Even with a cap ($2,100 in 2026, $2,400 in 2027), some people hit big drug costs early in the year — think expensive specialty medications where you could owe several hundred dollars in January alone.

The Medicare Prescription Payment Plan (sometimes called "M3P") is a free, optional program that lets you spread your out-of-pocket drug costs across the calendar year in monthly payments instead of paying the pharmacy at pickup.

A few important points:

• It does not save you money — you pay the same total, just on a monthly schedule.
• You still owe the full annual amount even if you leave the plan mid-year.
• You sign up through your Part D or Medicare Advantage drug plan, not at the pharmacy counter.
• It tends to help people with high early-year drug costs. If your drug costs are small and steady, it may actually make budgeting harder.

You can opt in before the plan year starts or at any point during the year.

How to avoid the most common mistakes this fall

Gardner is in Johnson County, where Medicare beneficiaries have a wide range of stand-alone Part D and Medicare Advantage drug plans to choose from. With rules changing, it's worth a fresh look — even if you've been happy with your current plan.

Watch out for these:

• Assuming your plan stays the same. Every fall, plans send an Annual Notice of Change (ANOC). Read it. Formularies, tiers, and pharmacy networks can shift.
• Ignoring the formulary. The cap only helps with covered drugs. Confirm your prescriptions are on the plan's list for 2027.
• Missing December 7. That's the deadline to change Part D or Medicare Advantage coverage for a January 1 start.
• Forgetting IRMAA. Higher-income beneficiaries pay a Part D surcharge. In 2026, IRMAA begins above $109,000 in income for a single filer (higher for joint filers).
• Signing up for the payment plan without doing the math. For some, it smooths costs. For others, it just adds a monthly bill.