Medicare Part D
Part D in Auburn: $2,100 yearly out-of-pocket cap
AUBURN, Maine — One of the biggest changes in Medicare's history took full effect on Jan. 1, 2026: a hard cap on what people with Part D drug coverage pay out of pocket in a year. That cap was $2,100 in 2026 and rises to $2,400 in 2027. Once you hit it, you pay nothing more for covered prescriptions for the rest of the calendar year.
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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.
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Key takeaways
- The Part D out-of-pocket drug cost cap is $2,100 in 2026 and $2,400 in 2027, and once you hit that limit you pay nothing more for covered prescriptions for the rest of the year.
- The Part D deductible can be no higher than $615 in 2026 and no higher than $700 in 2027, and the old coverage gap, or "donut hole," was eliminated in 2025.
- The Medicare Prescription Payment Plan lets you spread your Part D out-of-pocket costs into no-interest monthly installments instead of paying it all at once at the pharmacy.
- These rules apply to every plan with Medicare drug coverage, so it's still worth reviewing your plan's Annual Notice of Change each fall since drug lists, tiers, and pharmacy networks can change.
For older adults in Auburn who take costly medications — the kind that used to burn through a month's Social Security check in a single pharmacy visit — this is a meaningful shift. Here's a plain-English look at what's changing, and where to get trustworthy help locally.
The $2,100 cap, explained simply
Under Medicare Part D program rules, your out-of-pocket spending on covered prescription drugs is capped for the year — $2,100 in 2026 and $2,400 in 2027. That includes your deductible and your share of drug costs at the pharmacy counter. Monthly plan premiums don't count toward the cap.
Once you reach the yearly cap, you move into what Medicare calls the "catastrophic" phase, and you pay nothing more for your covered drugs until the year resets on Jan. 1.
The Part D deductible in 2026 can be no higher than $615, though many plans set it lower.
The "donut hole" is gone
For years, Medicare had a confusing middle stage called the coverage gap — the "donut hole" — where your costs jumped after you and your plan had spent a certain amount together. That gap was eliminated in 2025.
In 2027, Part D still has just three phases:
1. Deductible (if your plan has one). 2. Initial coverage — you pay a share of drug costs. 3. Catastrophic — you pay $0 for covered drugs after hitting the $2,100 cap.
Simpler math, and no more mid-year sticker shock.
The Medicare Prescription Payment Plan
Hitting $2,100 in January or February is possible for people on expensive specialty drugs. To help spread that out, Medicare offers the Medicare Prescription Payment Plan — an optional, no-interest program that lets you pay your Part D out-of-pocket costs in monthly installments across the plan year instead of all at once at the pharmacy.
A few things to know:
- It's optional. You have to opt in through your Part D or Medicare Advantage drug plan.
- It doesn't lower your total drug costs — it just smooths them into monthly bills.
- It works best for people with high or unpredictable drug spending, especially early in the year.
- You can join any time during the year, though joining before you fill a big prescription helps most.
If cash flow is the issue — not the total price — this program is worth asking your plan about.
What this means locally in Auburn
Auburn is in Androscoggin County, and like the rest of Maine, Medicare plan availability here is set at the county level. That means the same menu of stand-alone Part D plans and Medicare Advantage plans with drug coverage is available across the county, not just in the city limits.
The $2,100 cap and the payment plan aren't features of any one company — they're federal Part D rules that apply to every plan that includes Medicare drug coverage, whether it's a stand-alone Part D plan added to Original Medicare or a Medicare Advantage plan that bundles drugs in.
Dates to circle
- Oct. 15 – Dec. 7, 2026: Medicare's Annual Enrollment Period. This is when you can join, switch, or drop a Part D or Medicare Advantage plan for 2027.
- Jan. 1 – March 31, 2027: Medicare Advantage Open Enrollment Period. If you're already 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.
Even if you're happy with your current coverage, it's worth reading the Annual Notice of Change that your plan mails each fall. Formularies (drug lists), tiers, and pharmacy networks can shift year to year.
A note on higher-income enrollees
If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may owe an Income-Related Monthly Adjustment Amount, or IRMAA, on top of your Part B and Part D premiums in 2026. The $2,100 cap still applies to you — IRMAA is a premium surcharge, not an out-of-pocket cost at the pharmacy.
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 Androscoggin County
(MA penetration in Androscoggin 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 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 premium?
Do I have to sign up for the payment plan?
What if my drug isn't on my plan's list?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.