Medicare Part D

The 2027 Medicare Part D Cap in Greensboro, NC

GREENSBORO, N.C. — Starting Jan. 1, 2027, Medicare Part D will cap what you pay out of pocket for covered prescription drugs at $2,400 for the year, up from $2,100 in 2026. It's one of the biggest shifts the drug benefit has seen since it began in 2006, and it lands right as the Annual Enrollment Period (Oct. 15–Dec. 7) gets underway for Greensboro-area retirees choosing their 2027 coverage.

The change matters most if you take expensive medications. Once your covered drug costs hit $2,400, you pay nothing more for the rest of the calendar year on covered prescriptions. Here's what else changed, and the mistakes that are easiest to avoid.

The Part D cap, in plain English

Before 2025, there was no true ceiling on what a Medicare beneficiary could spend out of pocket for Part D drugs in a year. People taking specialty medications sometimes paid many thousands of dollars.

For 2027, Medicare has set the annual out-of-pocket maximum at $2,400 (it was $2,100 in 2026). Once your spending on covered drugs reaches that number — through deductibles and copays or coinsurance — your plan pays 100% of the cost for covered drugs for the rest of the year.

A few things to know:

• The cap applies to covered drugs. If your medication isn't on your plan's formulary, those costs don't count.
• Premiums don't count toward the $2,100 in 2026 ($2,400 in 2027).
• The cap resets each January 1.

The coverage gap is over

For years, Part D had four phases: deductible, initial coverage, the coverage gap (the "donut hole"), and catastrophic coverage. As of 2025, the coverage gap was eliminated. In 2027, Part D has three phases:

1. Deductible phase — you pay full negotiated price until you meet your plan's deductible (no more than $700 in 2027). 2. Initial coverage phase — you pay a copay or coinsurance; the plan pays the rest. 3. Catastrophic phase — once you hit $2,400 out of pocket, you pay nothing more for covered drugs that year.

Simpler math, and no more surprise mid-year price jumps when someone crossed into the old donut hole.

The Medicare Prescription Payment Plan

Even with the $2,400 cap, one large fill in January can hurt. That's where the Medicare Prescription Payment Plan comes in.

This is an optional program, run through your Part D or Medicare Advantage drug plan, that lets you spread your out-of-pocket drug costs across monthly payments over the rest of the calendar year instead of paying the full amount at the pharmacy.

A few points worth knowing:

• It doesn't lower your total drug costs — it just smooths them out.
• You pay $0 at the pharmacy for covered drugs; your plan bills you monthly.
• You have to opt in. You can sign up before the plan year starts or at any point during the year.
• It tends to help most if you have high drug costs early in the year, or predictable large fills.

Medicare has a fact sheet and calculator at medicare.gov to help you decide if it fits your situation.

Mistakes to avoid this enrollment season

Greensboro is in Guilford County, where Medicare beneficiaries have a wide range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. For 2027, Guilford County has 81 Medicare Advantage plans from 13 carriers, including AmeriHealth Caritas VIP Care, new to the county next year. With that many choices, small mistakes get expensive.

• Assuming your plan stays the same. Formularies, tiers, and pharmacy networks change every year. Read the Annual Notice of Change your plan sent in September.
• Ignoring the deductible. In 2027, plans can set a Part D deductible up to $700. Some are lower, some hit the max.
• Overlooking the payment plan option. If you've ever skipped a fill because of sticker shock, the Prescription Payment Plan is worth a look.
• Missing IRMAA. Higher-income beneficiaries pay an income-related surcharge on top of their Part D premium. For 2026, IRMAA begins above $109,000 in income for a single filer (based on your 2024 tax return).
• Waiting past Dec. 7. That's the last day to change your Part D or Medicare Advantage coverage for 2027 during the Annual Enrollment Period. If you're on Medicare Advantage, you get a second window Jan. 1–March 31 to switch MA plans or return to Original Medicare.

Where to get personal help

Medicare choices are personal — what works for your neighbor may not work for you. For unbiased, one-on-one help:

• medicare.gov — the official Plan Finder tool lets you enter your drugs and pharmacies to compare coverage.
• 1-800-MEDICARE (1-800-633-4227) — available 24/7.
• North Carolina SHIIP (Seniors' Health Insurance Information Program) — the state's free SHIP counseling service, reachable at 1-855-408-1212. Local SHIIP counselors serve Guilford County residents at no cost.