Medicare Part D

What the New Medicare Drug Cap Means in Yonkers

YONKERS, N.Y. — Starting January 1, 2027, no one with Medicare Part D drug coverage will pay more than $2,400 out of pocket for their prescriptions in a calendar year. The Part D out-of-pocket cap continues to tighten, and the next step arrives just as Yonkers residents finish making their plan choices during Fall Open Enrollment, which runs through December 7.

Here's what the new cap means, what happened to the old "donut hole," and how a new payment option can help you spread costs across the year.

The $2,100 cap, in plain English

In 2027, once your out-of-pocket spending on covered Part D drugs reaches $2,400, you pay nothing more for the rest of the year on those drugs. That limit applies whether your drug coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan.

A few details worth knowing:

• The cap counts what you pay for covered drugs — deductibles and copays or coinsurance.
• Monthly premiums do not count toward the $2,100.
• Drugs your plan doesn't cover don't count either. If a medication isn't on your plan's formulary, spending on it won't move you toward the cap.
• The maximum Part D deductible any plan can charge is $615 in 2026 and $700 in 2027, though many plans set it lower.

This is a program-wide rule set by Medicare, not something individual plans opt into.

The coverage gap is gone

For years, people with Medicare knew — and dreaded — the "donut hole," a stretch where you paid more out of pocket after hitting an initial coverage limit. That coverage gap was eliminated in 2025.

Part D now has three phases instead of four:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (up to $700 in 2027). 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.

For anyone taking expensive medications, this is the change that matters most. There is no more middle stage where costs suddenly jump.

The Medicare Prescription Payment Plan

Even with a $2,100 cap, hitting that number early in the year can still hurt if it lands in one or two big pharmacy bills. That's where the Medicare Prescription Payment Plan comes in.

It's a free, optional program that lets you spread your out-of-pocket drug costs across monthly payments instead of paying the pharmacy all at once. Here's how it works:

• You still get your prescriptions at the pharmacy — you just don't pay there.
• Your Part D plan bills you monthly for what you would have paid, spread over the remaining months of the year.
• Your total out-of-pocket cost for the year doesn't change; only the timing does.

You can sign up before the plan year starts or at any point during the year by contacting your Part D plan. It tends to help most people who expect high drug costs early in the year. It may not help someone with low, steady drug costs, since it doesn't reduce what you owe overall.

What Yonkers residents should check before December 7

Yonkers is in Westchester County, where 15 carriers offer 62 Medicare Advantage plans for 2027, alongside stand-alone Part D options. Plan formularies, pharmacy networks, and premiums can change from year to year — even if you keep the same plan.

Before Annual Enrollment ends on December 7, it's worth taking 20 minutes to:

• Log in at Medicare.gov and use the Plan Finder to check that your 2027 plan still covers your medications.
• Confirm your preferred pharmacy is still "in network" or "preferred."
• Review the Annual Notice of Change your current plan mailed you in September.
• Decide whether the Prescription Payment Plan makes sense for how you use your drugs.

If you miss December 7, Medicare Advantage members get a second window — the Medicare Advantage Open Enrollment Period from January 1 to March 31 — to switch Advantage plans or return to Original Medicare.

A note on higher-income enrollees

If your income is above $109,000 as a single filer (or $218,000 filing jointly) based on your 2024 tax return, you may owe an income-related monthly adjustment (IRMAA) on top of your Part B and Part D premiums in 2026. IRMAA is separate from the $2,100 cap and doesn't affect how the cap works.