Medicare Part D

Part D Out-of-Pocket Cap 2027: Concord, NH

CONCORD, N.H. — In 2027, no one with Medicare Part D will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year. It's a continuation of the biggest change to Part D in years, and it lands right as Concord-area retirees are sorting through their choices during Medicare's Annual Enrollment Period, which runs through December 7.

A real ceiling on drug costs continues in 2027

The cap builds on changes that took effect in 2025, when Medicare eliminated the old "donut hole" coverage gap and set the first-ever out-of-pocket ceiling at $2,000. The ceiling is $2,100 in 2026 and rises to $2,400 in 2027, according to CMS.

Here's what that means in plain English — and what else is changing in the Part D program for next year.

The Part D cap, in plain English

Under Part D rules for 2027:

• Once your out-of-pocket spending on covered prescriptions reaches $2,400 in a calendar year, you pay $0 for the rest of the year on those covered drugs.
• The Part D deductible can be no higher than $700 in 2027. (Plans may set it lower; they can't set it higher.)
• The counter resets every January 1.

Only what you pay counts toward the cap — your deductible and your share of the cost at the pharmacy. Your monthly premium does not count, and neither do drugs that aren't on your plan's formulary.

For someone in Concord managing a costly specialty medication, this is the practical difference: in past years, a serious diagnosis could mean thousands of dollars in drug costs stretched across the year. In 2027, the math stops at $2,400.

The "donut hole" is gone

If you've been on Medicare for a while, you probably remember the coverage gap — the stretch where your share of drug costs jumped after you and your plan had spent a certain amount together. That phase disappeared in 2025 and stays gone in 2027.

Part D now has just three phases:

1. Deductible phase — you pay the full negotiated price until you meet the plan's deductible (up to $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance while the plan pays the rest. 3. Catastrophic phase — once your out-of-pocket spending hits $2,400 in 2027, you pay nothing more for covered drugs that year.

Simpler, and easier to plan around.

The Medicare Prescription Payment Plan

Hitting the cap is helpful — but $2,400 in January still stings. That's where the Medicare Prescription Payment Plan comes in.

This is a free, optional program that lets you spread your out-of-pocket Part D costs across the calendar year in monthly payments instead of paying the full amount at the pharmacy counter. You still owe the same total; you just pay your Part D plan directly, in monthly installments, rather than the pharmacy up front.

A few things worth knowing:

• You must opt in — it's not automatic. You can sign up before the year starts or during the year.
• It's most useful for people expecting high drug costs, especially early in the year.
• It doesn't lower your total costs; it changes the timing.
• If a bill is skipped, you can be removed from the program, though your drug coverage itself continues.

Medicare.gov has an online tool to help you decide whether the payment plan makes sense for your situation.

A quick Concord snapshot

Concord sits in Merrimack County, and Part D and Medicare Advantage plan availability is set at the county level — not the city level. That means every Medicare-eligible resident in Concord chooses from the same menu of stand-alone Part D plans and Medicare Advantage plans with drug coverage that's offered to the rest of Merrimack County.

The $2,400 cap, the $700 maximum deductible, and the payment plan option apply in 2027 to every Part D plan sold in the county. Plans still differ on premiums, formularies, pharmacy networks, and cost-sharing before you reach the cap — so it's still worth comparing options during AEP. The 2027 lineup is in each plan's ANOC and on Medicare.gov's Plan Finder.

What about higher-income retirees?

If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you'll pay an IRMAA surcharge on top of your Part B and Part D premiums in 2026. IRMAA affects premiums, not the cap ($2,100 in 2026, $2,400 in 2027) — the cap applies to everyone with Part D regardless of income.

Key dates for Concord readers

• October 15 – December 7, 2026: Medicare Annual Enrollment Period. Changes take effect January 1, 2027.
• January 1, 2027: Updated Part D figures — including the $2,400 cap — take effect.
• January 1 – March 31, 2027: Medicare Advantage Open Enrollment Period. If you're already in a Medicare Advantage plan, you can switch to another MA plan or return to Original Medicare.