Medicare Part D

How the Part D $2,100 cap works for New Bedford Medicare

The Medicare Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027 for covered prescription drugs in a calendar year. Once you hit that number, your plan picks up 100% of the cost of covered drugs for the rest of the year.

New Bedford, Mass. — A hard ceiling on drug costs arrives Jan. 1

That's the single biggest change to Medicare drug coverage in a generation — and it's landing right as Annual Enrollment (Oct. 15 – Dec. 7) wraps up. If you take expensive medications, or you've ever been surprised by a pharmacy bill in the spring, this is the piece to read.

What the $2,100 cap actually means

The cap is a hard, annual limit on what you personally spend at the pharmacy for drugs your Part D plan covers. It applies to:

• Standalone Part D drug plans
• Medicare Advantage plans that include drug coverage (MA-PD)

A few things to keep in mind:

• Premiums don't count toward the $2,100. Only what you pay for covered drugs (deductible, copays, coinsurance) counts.
• Drugs your plan doesn't cover don't count. If a medication isn't on the plan's formulary, spending on it won't move you toward the cap.
• The maximum Part D deductible is $615 in 2026 and $700 in 2027. Plans can set a lower deductible, but not a higher one.

Once your out-of-pocket spending on covered drugs reaches $2,100, you pay $0 for those drugs for the rest of the plan year. The counter resets on January 1.

The "donut hole" is gone — here's what replaced it

For years, Part D had four confusing phases, including the infamous coverage gap, or "donut hole," where people paid more once their drug spending hit a certain point.

That gap was eliminated in 2025. Part D now has just three phases:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (up to $615 in 2026, up to $700 in 2027). 2. Initial coverage phase — you pay copays or coinsurance; the plan pays the rest. 3. Catastrophic phase — once your out-of-pocket costs reach the annual cap ($2,100 in 2026, $2,400 in 2027), you pay nothing more for covered drugs that year.

No more math about "true out-of-pocket" thresholds. No more sticker shock in June. The structure is finally something a normal person can follow.

The Medicare Prescription Payment Plan: spreading the bill out

Hitting a $2,100 cap is a relief — but for people whose expensive drugs are front-loaded early in the year, that bill can still land hard in January or February.

That's what the Medicare Prescription Payment Plan is for. It's a free, optional program (sometimes called "M3P") that lets you spread your out-of-pocket drug costs across monthly payments for the rest of the plan year, instead of paying the pharmacy all at once.

Key points:

• You still pay the same total amount — it's smoothed, not reduced.
• You pay $0 at the pharmacy counter for covered drugs; your Part D plan bills you monthly instead.
• You have to opt in through your Part D or MA-PD plan. It doesn't happen automatically.
• You can join before the plan year starts or at any point during the year.

If you take one high-cost medication and dread the January refill, ask your plan about signing up. If your drug costs are modest and spread evenly through the year, it may not save you any hassle.

What New Bedford residents should do before Dec. 7

New Bedford is in Bristol County, where Medicare beneficiaries choose from a range of standalone Part D plans and Medicare Advantage plans with drug coverage. Availability is set at the county level by CMS each year.

Two dates matter right now:

• Oct. 15 – Dec. 7, 2026: Annual Enrollment Period. You can join, switch, or drop a Part D or Medicare Advantage plan. Changes take effect Jan. 1, 2027.
• Jan. 1 – Mar. 31: Medicare Advantage Open Enrollment. If you're already in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare.

Before Dec. 7, it's worth checking:

• Is every drug you take still on your plan's formulary for 2027?
• Did your plan send an Annual Notice of Change (ANOC)? Read it.
• Would the Prescription Payment Plan help smooth your costs?

You can compare plans yourself using the Plan Finder at medicare.gov, call 1-800-MEDICARE (24/7), or get free, unbiased help from Massachusetts's SHINE program (the state's SHIP counselor service).

A quick note on higher earners (IRMAA)

If your modified adjusted gross income is above $109,000 for a single filer (or $218,000 for a couple) in 2026, you'll pay an Income-Related Monthly Adjustment Amount on top of your Part B and Part D premiums. The $2,100 cap still applies to you — IRMAA affects premiums, not your out-of-pocket drug spending.