Medicare Part D

Part D Drug Cap in 2027: New Bern, N.C.

NEW BERN, N.C. — Starting January 1, 2027, no one with a Medicare Part D plan will pay more than $2,400 out of pocket for covered prescription drugs in a calendar year. The cap rises from $2,100 in 2026, and the change lands right in the middle of Annual Enrollment, which runs through December 7.

For people in New Bern who have been juggling high pharmacy bills, this is worth understanding before you pick a plan for 2027.

The new Part D cap, in plain English

Under Medicare Part D program rules, once your out-of-pocket spending on covered drugs hits the annual cap, you pay nothing for the rest of the year on those drugs. The cap is $2,100 in 2026 and $2,400 in 2027. It's indexed to rise a bit each year going forward.

A few things to keep in mind:

• The cap counts what you pay for covered drugs — deductibles, copays, and coinsurance at the pharmacy.
• It does not include your monthly premium.
• It only applies to drugs your plan actually covers (its formulary). If a medication isn't covered, those costs don't count toward the cap.
• The maximum Part D deductible any plan can charge is $615 in 2026 and $700 in 2027. Plans can charge less, but not more.

The "donut hole" is gone — here's what replaced it

For years, Part D had four phases, including the confusing "coverage gap" or donut hole where costs could jump midyear. That gap was eliminated in 2025.

In 2027, there are just three phases:

1. Deductible — you pay full negotiated price until you meet your plan's deductible (up to $700 in 2027). 2. Initial coverage — you pay a copay or coinsurance for each prescription. 3. Catastrophic coverage — once your out-of-pocket total hits the annual cap ($2,400 in 2027), you pay nothing more for covered drugs that year.

For people on expensive medications — think certain cancer drugs, blood thinners, or specialty biologics — hitting the cap early in the year is realistic. After that, refills cost nothing at the pharmacy counter for the rest of 2027.

The Medicare Prescription Payment Plan: smoothing the bill

Here's the part a lot of folks miss. Even with the annual cap, you could still owe a big bill in one month if an expensive prescription lands in January.

The Medicare Prescription Payment Plan — sometimes called "M3P" — lets you spread your out-of-pocket drug costs across the calendar year in monthly installments instead of paying the pharmacy all at once. It's free to join, but you have to opt in.

A few points from CMS:

• It doesn't lower what you owe overall — it just changes when you pay.
• You pay $0 at the pharmacy; the plan bills you monthly instead.
• It usually helps most for people with high drug costs early in the year.
• It may not help — and could actually feel worse — for people with low, steady drug costs, because you'd get bills even in months you didn't fill a prescription.

You can ask your Part D or Medicare Advantage drug plan to enroll you at any time during the year. Your plan is required to tell you if it looks like you'd benefit.

What this means for people in Craven County

New Bern is in Craven County, where residents choose from a range of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. The county-level plan lineup for 2027 is in each plan's Annual Notice of Change and on medicare.gov's Plan Finder.

The annual out-of-pocket cap, the maximum deductible, and the payment plan option apply to every Part D plan nationwide — that's set by federal law, not by the individual plans. What varies plan to plan is the premium, the formulary (which drugs are covered and at what tier), the pharmacy network, and the deductible amount.

If you're comparing options during Annual Enrollment, the biggest questions to ask are:

• Are my specific medications on this plan's formulary?
• What tier are they on, and what's the copay?
• Is my regular pharmacy in the preferred network?

Key dates to circle

• October 15 – December 7, 2026: Medicare Annual Enrollment Period. Changes you make take effect January 1, 2027.
• January 1 – March 31: Medicare Advantage Open Enrollment. If you're already on an Advantage plan, you get one chance to switch to a different Advantage plan or return to Original Medicare with a Part D plan.
• Any time during the year: You can enroll in the Medicare Prescription Payment Plan.

One more figure worth knowing: IRMAA — the income-related surcharge that raises Part B and Part D premiums for higher earners — kicks in above $109,000 in income for a single filer in 2026 (based on your 2024 tax return).