Medicare Part D

Silver Spring, MD: Part D Cap for 2027

# Silver Spring seniors: your drug bill stops at $2,100 in 2026 ($2,400 in 2027) in…

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2027 DRUG LIST ALERT

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

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Pharmacy prescription counter in Silver Spring — illustrating this Medicare guide — Photo: Nathan Anderson Photo by Nathan Anderson on Unsplash

By The Medicare Desk · Medicare Education Desk

Published 2026-09-22·Updated 2026-10-07·8 min read·✓ Reviewed·● Silver Spring, MD

Key takeaways

The annual out-of-pocket cap on covered Part D drugs is $2,100 in 2026 and $2,400 in 2027, and once you hit it, you pay nothing more for covered drugs for the rest of the year.
The old "donut hole" coverage gap is gone; Part D now has three phases — deductible, initial coverage, and catastrophic.
The Part D deductible can be no higher than $615 in 2026 and $700 in 2027, though plans may set it lower.
The Medicare Prescription Payment Plan lets you spread your drug costs into monthly bills instead of paying big amounts at the pharmacy counter.

SILVER SPRING, Md. — Starting Jan. 1, 2027, no one with Medicare Part D will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year (the cap is $2,100 in 2026). For Montgomery County residents who have watched pharmacy receipts pile up, that ceiling — combined with the option to spread payments across the year — remains the biggest change to Part D in a generation.

What the Part D cap actually covers

The cap applies to what you spend out of pocket on prescriptions covered by your Part D plan — whether that plan is stand-alone or built into a Medicare Advantage plan. Deductibles, copays, and coinsurance for covered drugs all count toward the cap.

What doesn't count: premiums, drugs your plan doesn't cover, and medications bought outside the plan's pharmacy network. Part B drugs (like many infusions given in a doctor's office) also aren't part of this cap — those follow different rules.

Once your out-of-pocket spending reaches the annual cap, you pay nothing more for covered Part D drugs through the end of the year. The count resets each Jan. 1.

The coverage gap is really gone

For years, Part D worked in four phases, and the third one — the "donut hole" — was where people on expensive medications suddenly faced much higher costs midyear. That phase was eliminated in 2025 and stays gone in 2026 and 2027.

Part D now has three phases:

1. Deductible phase. You pay full negotiated price until you meet your plan's deductible (maximum $615 in 2026 and $700 in 2027; some plans set it lower or waive it). 2. Initial coverage phase. You pay a copay or coinsurance while the plan pays the rest, until your out-of-pocket total hits the annual cap ($2,100 in 2026, $2,400 in 2027). 3. Catastrophic phase. You pay nothing for covered drugs for the rest of the year.

That's it. No more sticker shock in the middle of the year.

The Medicare Prescription Payment Plan explained

Even with the annual cap, hitting that number in January or February at the pharmacy counter can strain a fixed income. That's where the Medicare Prescription Payment Plan (sometimes called "M3P") comes in.

It's a free option. You sign up through your Part D plan, and instead of paying the pharmacy at pickup, your plan bills you monthly. Your total yearly cost doesn't change — the cap is still $2,100 in 2026 and $2,400 in 2027 — but the payments are smoothed out across the remaining months of the year.

Who tends to benefit most: people expecting a large drug bill early in the year, or anyone who'd rather budget a predictable monthly amount than face a surprise at the counter. If your drug costs are low and steady, the paperwork may not be worth it. You can opt in at any point in the year by contacting your plan.

What Silver Spring residents should do this fall

Silver Spring is in Montgomery County, where residents have a wide range of stand-alone Part D and Medicare Advantage plans to choose from. The 2027 lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder. Every plan sets its own formulary (the list of covered drugs), pharmacy network, and cost-sharing structure — so even with the same federal cap, plans can differ a lot in how quickly you reach it.

A few practical steps during the Annual Enrollment Period (Oct. 15 – Dec. 7, 2026, for coverage starting Jan. 1, 2027):

Log in to medicare.gov and use the Plan Finder with your current medication list. It shows your estimated yearly drug costs under each plan available in your ZIP code.
Check whether your regular pharmacy is in the plan's preferred network.
If your income is above $109,000 (single) or $218,000 (joint), factor in IRMAA — an income-based surcharge added to Part D and Part B premiums.
If you miss AEP, Medicare Advantage members get another window Jan. 1 – March 31 to switch Advantage plans or drop back to Original Medicare.

Free, unbiased help is available through Maryland's State Health Insurance Assistance Program (SHIP), reachable at 1-800-243-3425.

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 Montgomery County

23% are on Medicare Advantage
(MA penetration in Montgomery County)

23%

77%

Medicare Advantage Medicare Supplement (Medigap) Original Medicare only

U.S. average

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 a hard yearly cap on what you pay out of pocket for covered drugs — $2,100 in 2026 and $2,400 in 2027 — and you can spread those costs across the year with the Medicare Prescription Payment Plan.

Phase 1

Deductible

You pay full price for covered drugs until you meet your plan's deductible (no more than $615 in 2026).

Phase 2

Initial coverage

You and your plan share costs through copays or coinsurance.

Phase 3

Catastrophic coverage

Once your out-of-pocket drug spending hits $2,100, you pay nothing more for covered drugs for the rest of the year.

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.

Your total yearly drug costs$3,000

$2,100 cap

$1,211estimated out-of-pocket

$0saved by the cap

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

JFMAMJJASOND

October 15 – December 7 — anyone with Medicare can join, switch, or drop a Medicare Advantage or Part D plan. Changes take effect January 1.

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 apply to Medicare Advantage plans too?

Yes. If your Medicare Advantage plan includes prescription drug coverage (most do), the same annual out-of-pocket cap applies to covered Part D drugs — $2,100 in 2026 and $2,400 in 2027.

Do I have to sign up for the Prescription Payment Plan, or is it automatic?

It's not automatic. You have to opt in through your Part D plan. You can enroll before the year starts or at any point during the year, though signing up earlier gives you more months to spread costs over.

What happens if I switch plans midyear? Does my $2,100 total reset?

Generally, your out-of-pocket total carries with you when you switch during a valid enrollment period within the same year. Confirm with your new plan and keep records of what you've already paid.

Are insulin and vaccines part of the cap?

Covered insulins are capped at $35 for a month's supply under Part D, and recommended adult vaccines are $0. What you pay toward insulin still counts toward your out-of-pocket total. ## Where to get answers you can trust For personalized guidance, start with medicare.gov or call 1-800-MEDICARE (1-800-633-4227), available 24/7. Maryland residents can also reach SHIP counselors at 1-800-243-3425 for free, one-on-one help comparing plans — no sales pressure, no commissions.

Sources & further reading

CMS — Medicare Part D program rules (medicare.gov)

For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.

Also for Silver Spring

Medicare Advantage in Silver Spring Medicare Supplement in Silver Spring Medicare 2026 in Silver Spring

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This page was last updated: October 7, 2026.