Medicare Part D

Big Part D change hits Biloxi Jan. 1: your drug bill is capped

On Jan. 1, 2027, the Part D out-of-pocket cap moves to its next level — and plan notices are landing in mailboxes across Biloxi this fall. For the third year in a row, there is no "donut hole." And in 2027, no one with a Medicare Part D plan will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year.

If you or a loved one on Medicare in Harrison County has ever stared at a pharmacy receipt and wondered how high the bill could climb, this is the change to understand.

What the $2,100 cap actually means

The out-of-pocket ceiling for covered Part D drugs is $2,100 in 2026 and $2,400 in 2027. It applies whether your drug coverage comes through a stand-alone Part D plan or through a Medicare Advantage plan that includes drug coverage.

A few things to keep in mind:

• The cap counts what you pay for covered drugs — deductibles and copays or coinsurance at the pharmacy.
• Monthly plan premiums do not count toward the $2,100.
• Drugs your plan does not cover do not count either. That is why checking a plan's formulary matters.
• The Part D maximum deductible is $615 in 2026 and $700 in 2027, set by CMS. Plans can charge less, but not more.

Once you hit $2,100 in out-of-pocket spending on covered drugs, you pay $0 for the rest of the calendar year for those covered prescriptions.

The "donut hole" is really gone

For years, Medicare drug coverage had a confusing middle stage — the coverage gap, often called the donut hole — where people suddenly paid a bigger share of their drug costs. That gap was eliminated starting in 2025.

Now Part D has three phases:

1. Deductible phase — you pay the full negotiated price until you meet your plan's deductible (up to $615 in 2026 and up to $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance, and your plan pays the rest, until your out-of-pocket spending reaches the annual cap ($2,100 in 2026, $2,400 in 2027). 3. Catastrophic phase — you pay $0 for covered drugs the rest of the year.

That is the whole structure. No more surprise price jumps in the middle of the year.

The Medicare Prescription Payment Plan: smoothing the bill

Even with a $2,100 cap, some people hit big drug costs early — a single specialty medication can push you toward the cap in January or February. That is where the Medicare Prescription Payment Plan comes in.

It is a free, optional program from CMS. Instead of paying the pharmacy hundreds (or more) at once, your plan bills you in monthly installments spread across the rest of the calendar year. You still owe the same total — it is not a discount — but the cash flow is easier to manage.

Who tends to benefit most:

• People with one or more high-cost drugs.
• People whose drug costs hit hard in the first few months of the year.
• People on a fixed monthly income who would rather budget than face a large pharmacy bill.

You can sign up before the year starts or any time during the year. Ask your Part D or Medicare Advantage plan how to opt in, or call 1-800-MEDICARE.

How to decide during Biloxi's fall enrollment window

Biloxi is in Harrison County, where a range of stand-alone Part D and Medicare Advantage plans is offered each year. During Annual Enrollment (Oct. 15 – Dec. 7, 2026), you can compare plans for 2027 and switch if a different one fits better. The 2027 lineup is detailed in each plan's ANOC and on Medicare.gov's Plan Finder.

A practical checklist:

• Read your Annual Notice of Change (ANOC). Your current plan mails it in the fall. It shows what is changing for 2027 — premium, deductible, formulary, and pharmacy network.
• List your prescriptions. Include dosage and how often you fill them.
• Use the Plan Finder at medicare.gov. Enter your drugs and preferred pharmacy to see estimated yearly costs under each plan.
• Check the formulary. The annual cap only helps if your medications are actually covered.
• Ask about the payment plan. If you expect high drug costs, confirm how the plan handles enrollment in the Prescription Payment Plan.

If you have higher income, remember that IRMAA surcharges start above $109,000 for a single filer in 2026 and can add to your Part B and Part D premiums.

Where to get unbiased help

You do not have to figure this out alone, and you do not have to rely on a sales call. In Mississippi, the State Health Insurance Assistance Program (SHIP) offers free, one-on-one Medicare counseling. Counselors do not sell plans — they help you compare.

You can also:

• Visit medicare.gov to use the Plan Finder and read official rules.
• Call 1-800-MEDICARE (1-800-633-4227), available 24/7.
• Contact Mississippi SHIP through the state Department of Human Services.