Medicare Part D

Medicare Part D in Charlotte, NC: 2027 Update

CHARLOTTE, N.C. — Starting January 1, 2027, no one with Medicare Part D drug coverage will pay more than $2,400 out of pocket for covered prescriptions in a calendar year. It's one of the biggest shifts in how Medicare pays for medications in decades, and for people in Charlotte weighing their options during Annual Enrollment (October 15 – December 7), it changes the math on what a drug plan is really worth.

Here's a plain-English guide to the new cap, the end of the old "donut hole," and a payment option that can spread big drug bills across the year.

The $2,100 cap, explained

The Part D out-of-pocket cap is $2,100 in 2026 and $2,400 in 2027. Once your spending on covered drugs reaches that amount, you pay nothing for the rest of the calendar year on those medications.

This cap applies whether your drug coverage comes through a standalone Part D plan or is built into a Medicare Advantage plan that includes drug coverage. It resets each January 1.

A few things to keep in mind:

• The cap only counts spending on drugs that are covered by your plan. Drugs your plan doesn't cover don't count toward it.
• Part D plans can still charge an annual deductible, up to a maximum of $615 in 2026.
• Premiums you pay for the plan itself don't count toward the $2,100.

Goodbye, "donut hole"

If you've had Medicare for a while, you probably remember the coverage gap — the confusing middle stretch known as the donut hole, where your share of drug costs used to jump.

That phase is gone. As of 2025, Part D has just three phases:

1. Deductible phase — you pay full negotiated cost until you meet the plan's deductible (if it has one). 2. Initial coverage phase — you pay copays or coinsurance while the plan pays its share. 3. Catastrophic phase — once your out-of-pocket spending hits the annual cap, you pay nothing more for covered drugs that year.

In 2027, the catastrophic phase begins once your out-of-pocket spending on covered drugs reaches $2,400. No more surprise price jump in the middle of the year.

The Medicare Prescription Payment Plan

Hitting a $2,100 ceiling is good news over 12 months. But what if a big prescription hits in January and you get billed hundreds of dollars at the pharmacy counter all at once?

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 the calendar year in monthly payments, rather than paying the pharmacy in one lump sum.

A few basics:

• You still owe the same total amount — the program doesn't reduce your costs, it just smooths them out.
• You pay Medicare (through your plan) monthly instead of paying the pharmacy directly for covered drugs.
• Every Part D plan and every Medicare Advantage plan with drug coverage must offer it.
• You can opt in any time during the year by contacting your plan, though signing up before you fill an expensive prescription tends to work best.

This tends to help most if you take a high-cost drug early in the year, when a single fill could push you close to the cap in one visit.

Who this matters most for

For a lot of people in Mecklenburg County, drug spending never gets near $2,100 in a year. If that's you, the cap is a safety net you may never touch — but it's still there.

For people taking specialty medications for conditions like cancer, multiple sclerosis, or rheumatoid arthritis, the cap can be a meaningful change. It replaces what used to be open-ended coinsurance in the catastrophic phase with a firm annual ceiling.

Also worth noting: higher-income beneficiaries still pay IRMAA surcharges on their Part B and Part D premiums. For 2026, those surcharges begin above $109,000 in income for a single filer (based on your tax return from two years earlier).

What to do during Annual Enrollment

Charlotte is in Mecklenburg County, where a range of standalone Part D plans and Medicare Advantage plans with drug coverage are available. For 2027, the county has 79 Medicare Advantage plans from 12 carriers, including Alignment Health Plan as a carrier new to the county. Plans can change their formularies (the list of covered drugs), pharmacy networks, and cost-sharing from year to year — so the plan that worked in 2026 isn't automatically the right fit for 2027.

A few steps that tend to help:

• Read your Annual Notice of Change (ANOC), which your current plan mailed in September. It shows what's changing in 2027.
• Check that your drugs are still on the formulary for 2027 and at a tier you can afford.
• Use the Plan Finder at Medicare.gov to compare plans side by side using your actual drug list.
• Note the dates: Annual Enrollment runs October 15 – December 7. If you're already in a Medicare Advantage plan, you have a second window January 1 – March 31 to make one switch.