Medicare Part D

2027 Part D cap update for Plattsburgh, N.Y.

PLATTSBURGH, N.Y. — If you take prescription drugs and have Medicare, the Part D out-of-pocket cap continues in 2027 at an adjusted amount. Here is a plain-language walk-through of how the coverage works, what the numbers are for 2027, and where to get help in Clinton County.

What Part D is, in one paragraph

Part D is Medicare's prescription drug benefit. It's sold by private insurance companies that Medicare approves, and you can get it two ways: as a stand-alone drug plan that sits next to Original Medicare, or built into a Medicare Advantage plan. Either way, the same federal rules set the outer limits on what a plan can charge you.

The 2027 numbers to remember

Two figures do most of the work for the coming year:

• $700 maximum deductible. Before your plan starts paying its share, you may have to pay full price for your drugs up to this amount. Some plans set a lower deductible, or none at all, but no Part D plan can charge more than $700 in 2027.
• $2,400 out-of-pocket cap. Once what you have paid for covered drugs hits $2,400 for the year, you pay nothing more for the rest of 2027 on those drugs. This cap started at $2,000 in 2025, was $2,100 in 2026, and is adjusted each year.

These figures come from the Centers for Medicare & Medicaid Services (CMS), which sets Part D program rules each year on medicare.gov.

The three phases of Part D in 2027

Since 2025, the coverage gap (the “donut hole”) is gone. Part D now moves through three phases:

1. Deductible phase. You pay the full negotiated price for your drugs until you meet your plan's deductible (up to $700 in 2027). If your plan has no deductible, you skip this phase.

2. Initial coverage phase. You pay a copay or a percentage (coinsurance) for each prescription, and your plan pays the rest. You stay here until your total out-of-pocket spending on covered drugs reaches $2,400 in 2027.

3. Catastrophic phase. Once you hit the $2,400 cap in 2027, you pay nothing more for the rest of the calendar year for drugs covered by your plan's formulary.

The counter resets on January 1 each year.

The Medicare Prescription Payment Plan

Even with the cap, a big pharmacy bill in January can sting. That is where the Medicare Prescription Payment Plan comes in. It's a free option that lets you spread your yearly Part D drug costs into monthly payments over the calendar year, instead of paying the pharmacy in one lump when you pick up the prescription. You still pay the same total; it's just smoothed out. You can opt in through your Part D plan.

A note about higher-income enrollees (IRMAA)

Most people pay only their Part D plan's premium. But if your income is above $109,000 as a single filer (or $218,000 for a couple filing jointly) based on your 2024 tax return, Social Security adds an income-related surcharge called IRMAA to your Part D premium. If your income has dropped due to a life event like retirement, you can ask Social Security to reconsider.

Plattsburgh and Clinton County: what's available

Plattsburgh is in Clinton County, where residents can choose from stand-alone Part D drug plans as well as Medicare Advantage plans that include drug coverage. The specific plan lineup changes every year, so it's worth checking the official Plan Finder at medicare.gov each fall — even if you like your current plan — to make sure your drugs are still on the formulary and your pharmacy is still in network.

When you can enroll or switch

Two windows matter most:

• Annual Enrollment Period: October 15 – December 7. This is when anyone with Medicare can join, drop, or switch a Part D or Medicare Advantage plan for the following year.
• Medicare Advantage Open Enrollment: January 1 – March 31. If you're already in a Medicare Advantage plan, you get one chance in this window to switch to a different Advantage plan or return to Original Medicare (and add a stand-alone Part D plan).

Special Enrollment Periods may also apply if you move, lose other coverage, or qualify for Extra Help.