Medicare Part D

$2,400 Part D cap reaches Great Falls in 2027

GREAT FALLS, Mont. — If you take prescription medicines and have Medicare, 2027 brings another change to Part D drug coverage. Starting January 1, no one with a Medicare drug plan will pay more than $2,400 out of pocket for covered prescriptions in a calendar year. Once you hit that cap, your covered drugs cost you $0 for the rest of the year.

This is worth understanding before the Annual Enrollment Period closes on December 7.

The Part D cap, in plain English

For 2026, the Part D out-of-pocket maximum rises from $2,000 (the 2025 figure) to $2,100, according to CMS. That cap applies to what you spend on covered drugs — deductibles and copays or coinsurance you pay at the pharmacy. Monthly plan premiums don't count toward the cap.

The cap applies whether your drug coverage comes through a stand-alone Part D plan or through a Medicare Advantage plan that includes drug coverage. It resets every January 1.

Goodbye, "donut hole"

For years, Medicare drug coverage had four phases, including the confusing coverage gap — the "donut hole" — where costs could jump partway through the year. That gap was eliminated in 2025 and stays gone in 2027.

Now there are just three phases:

• Deductible phase. You pay full negotiated price until you meet your plan's deductible. The maximum allowed deductible is $615 in 2026 and $700 in 2027, though plans can set it lower.
• Initial coverage phase. You pay a copay or coinsurance while your plan pays the rest.
• Catastrophic phase. Once your out-of-pocket spending hits the yearly cap — $2,100 in 2026, $2,400 in 2027 — you pay nothing for covered drugs for the rest of the year.

That's it. No more math about which "phase" you're in and whether your February pharmacy trip will suddenly cost triple in July.

The Medicare Prescription Payment Plan

Even with the cap, $2,400 landing in January or February can hurt. That's why CMS also offers the Medicare Prescription Payment Plan — sometimes called "M3P" or drug cost smoothing.

Here's how it works: instead of paying the pharmacy at the counter, you opt in through your drug plan. Then your yearly drug costs get spread across monthly bills from the plan for the rest of the calendar year. Your total for the year doesn't change — in 2027 the cap is still $2,400 — but the timing does.

A few things to know:

• It's optional and free to join. You can sign up before the plan year or during it.
• It generally helps people whose drug costs are high early in the year, or who take one or more expensive medications.
• It may not help — and could feel like extra paperwork — if your prescription costs are low or spread evenly through the year.
• If you miss a monthly bill, you can be removed from the program, though you still get to use your regular drug coverage.

You sign up through your Part D or Medicare Advantage drug plan directly, not through Medicare.gov.

How Great Falls fits in

Great Falls is in Cascade County, and Medicare drug plan availability is set at the county level. Both stand-alone Part D plans and Medicare Advantage plans with drug coverage are sold here. The 2027 plan lineup is detailed in each plan's Annual Notice of Change and on Medicare.gov's Plan Finder. The federal rules above — the $2,400 cap in 2027, the $700 maximum deductible in 2027, the payment plan option — apply to every Part D plan sold in Cascade County, regardless of which company offers it.

How to think through your choice this fall

The Annual Enrollment Period runs October 15 through December 7. If you already have a plan, you don't have to do anything — your coverage will renew. But it's still worth a look, because plans can change formularies (the list of covered drugs), pharmacy networks, and premiums each year.

A few questions to ask yourself:

1. Are all my current prescriptions still on my plan's 2026 formulary? Your plan mails an Annual Notice of Change each fall. That's where to check. 2. Is my pharmacy still in the preferred network? 3. Would the Prescription Payment Plan actually help me? If your yearly drug costs are modest and steady, probably not. If you have one high-cost drug hitting early in the year, it might be worth asking about. 4. Is my income above $109,000 (single) or $218,000 (joint)? If so, IRMAA surcharges may apply to your Part B and Part D premiums in 2026.

If any of those answers give you pause, use Plan Finder on Medicare.gov to compare — or get free, unbiased help from Montana's State Health Insurance Assistance Program (SHIP).