Medicare Part D
The Part D Donut Hole Stays Gone for White Plains Medicare
WHITE PLAINS, N.Y. — Starting January 1, 2027, no one with Medicare Part D will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year. That's the highest-profile change in a wave of Part D updates taking effect this coming plan year, and it lands right as Westchester County residents sort through their choices during Medicare's Annual Enrollment Period, which runs October 15 through December 7.
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Click to call 855-729-3240Key takeaways
- Starting January 1, 2027, out-of-pocket costs for covered Part D prescription drugs are capped at $2,400 per calendar year, up from the $2,100 cap in 2026.
- As of 2025, the old four-phase Part D benefit (including the "donut hole" coverage gap) was replaced with three simpler phases: deductible, initial coverage, and catastrophic, and in 2027 plans can charge a maximum deductible of $700.
- The Medicare Prescription Payment Plan is a free, optional program offered through every Part D and Medicare Advantage drug plan that lets you spread your out-of-pocket drug costs into monthly installments instead of paying it all at the pharmacy, though the total amount owed stays the same.
- For 2026, higher-income enrollees pay an added IRMAA surcharge on Part B and Part D premiums if their modified adjusted gross income is above $109,000 for single filers or $218,000 for joint filers, based on 2024 tax returns.
A Real Ceiling on Drug Costs Starts Jan. 1
For older adults in White Plains who take expensive medications — think brand-name drugs for cancer, autoimmune conditions, blood thinners, or diabetes — this cap can meaningfully change how a year of prescriptions feels. Once you hit $2,400 in out-of-pocket spending on covered drugs, you pay nothing more for the rest of the year on those prescriptions.
What Actually Changed, in Plain English
The $2,400 cap for 2027 is an increase from the $2,100 cap in 2026, which itself followed the $2,000 cap that took effect in 2025 (it's indexed each year). But the bigger structural shift already happened, and it's worth understanding because it affects how you reach the cap.
The old Part D benefit had four phases, including the infamous "donut hole" — a coverage gap where you paid a larger share of costs after your plan hit a spending threshold. The coverage gap is gone. As of 2025, Part D has three simpler phases:
1. Deductible phase — You pay full negotiated price until you meet your plan's deductible. In 2027, the maximum deductible any plan can charge is $700. Some plans set it lower. 2. Initial coverage phase — You pay a copay or coinsurance; your plan pays the rest. 3. Catastrophic phase — Once your out-of-pocket spending hits $2,400, you pay nothing more for covered drugs the rest of the year.
That's it. No more donut hole math.
The Medicare Prescription Payment Plan: Spreading the Bill
Even with the cap, $2,400 in January or February is a shock for someone on a fixed income. That's the problem the Medicare Prescription Payment Plan is designed to solve.
It's a free, optional program available through every Part D plan and every Medicare Advantage plan with drug coverage. Instead of paying the pharmacy directly at pickup, you can choose to have those out-of-pocket costs billed to you in monthly installments spread across the rest of the calendar year. You still owe the same total — the payment plan doesn't lower drug prices — but it evens out the timing.
This can be helpful if you know a big prescription cost is coming early in the year. You have to opt in, either before the plan year starts or any month during the year. You can enroll by contacting your drug plan directly.
The Local Picture in Westchester County
White Plains sits in Westchester County, where — like everywhere else in the country — Part D plans are offered by private insurers under Medicare's rules. The $2,400 cap, the $700 maximum deductible, and the payment plan option apply to every Part D plan and every Medicare Advantage plan with drug coverage sold in the county. These are federal program rules, not plan features.
What varies plan to plan is the premium, the formulary (the list of covered drugs), the pharmacy network, and where specific drugs fall on the plan's tiers. That's why running your own drug list through Medicare's Plan Finder at medicare.gov matters — two people on the same street can have very different results depending on what's in their pill organizer.
A Note on Higher Incomes and IRMAA
If your income is above certain thresholds, you pay an income-related monthly adjustment amount (IRMAA) on top of your Part B and Part D premiums. For 2026, IRMAA surcharges begin above $109,000 in modified adjusted gross income for a single filer (and above $218,000 for a married couple filing jointly), based on your 2024 tax return. Social Security notifies you if you owe it, and there's an appeal process if your income has dropped since then — for example, after retirement.
Key Dates to Keep in Mind
- October 15 – December 7: Annual Enrollment Period. Switch Part D or Medicare Advantage plans; changes take effect Jan. 1.
- January 1, 2027: New $2,400 cap and $700 maximum deductible take effect.
- January 1 – March 31: Medicare Advantage Open Enrollment Period. If you're already in a Medicare Advantage plan, you get one chance to switch to another MA plan or return to Original Medicare.
By the numbers
Medicare Part B premium, 2006–2026
The standard monthly Part B premium has climbed from $88.50 in 2006 to $202.90 in 2026. Hover any point for that year’s premium.
Source: CMS. Standard premium shown; in some hold-harmless years many existing enrollees paid less. Confirm at Medicare.gov.
By the numbers
How people get Medicare in Westchester County
(MA penetration in Westchester County)
MA penetration from CMS enrollment data; Medigap share is an estimate. U.S. average is about 54% Medicare Advantage. These are area-level figures, not plan-specific.
Prescription coverage
How Medicare Part D works in 2027
The old coverage gap (“donut hole”) is eliminated as of 2025 (three phases now). There’s now a hard yearly cap of $2,400 in 2027 on what you pay out of pocket for covered drugs, and you can spread those costs across the year with the Medicare Prescription Payment Plan.
Try it
How the 2026 Part D drug cap works
Slide to your estimated yearly prescription costs and see how the new $2,100 out-of-pocket cap protects you. This illustrates the standard Part D benefit; your plan may structure costs differently.
Once your out-of-pocket spending on covered drugs reaches $2,100, you pay nothing more for the rest of 2026. Confirm details at Medicare.gov.
Explore
When can you enroll? An interactive year
Enrollment windows are federal and the same nationwide. Confirm your personal dates at Medicare.gov or 1-800-MEDICARE.
Good to know
Frequently asked questions
Does the $2,100 cap include my monthly premium?
If I don't take expensive drugs, does any of this matter to me?
Do I have to sign up for the payment plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.