Medicare Part D
Raleigh, N.C.: The 2027 Part D Cap Explained
RALEIGH, N.C. — Starting January 1, 2027, no one with a Medicare Part D drug plan will pay more than $2,400 out of pocket for covered prescriptions in a calendar year. The out-of-pocket cap that reshaped Part D in 2026 continues, and for people in Wake County who take costly drugs, it keeps changing the math on Part D in a real way.
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Will your prescriptions still be covered in 2027?
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Key takeaways
- The Part D out-of-pocket cap on covered drugs is $2,100 in 2026 and $2,400 in 2027.
- The old "donut hole" coverage gap is gone, leaving just three phases: deductible (up to $700 in 2027), initial coverage, and catastrophic coverage where you pay nothing more.
- The optional, free Medicare Prescription Payment Plan lets you spread your drug costs into monthly installments across the year instead of paying it all upfront, though the total amount owed stays the same.
- The cap ($2,100 in 2026, $2,400 in 2027) and three-phase structure are set by federal law and apply to every Part D plan nationwide, but formularies, pharmacy networks, deductibles, and copays still vary by plan.
Here's a plain-English guide to what's new, what's ending, and the optional payment plan that could help you spread costs across the year.
The Part D cap, in one paragraph
Once your out-of-pocket spending on covered Part D drugs reaches $2,400 in 2027, you pay nothing for those covered drugs for the rest of the year. This cap applies whether your prescription coverage comes through a stand-alone Part D plan or is built into a Medicare Advantage plan with drug coverage. The cap only counts spending on drugs your plan covers — premiums and drugs your plan doesn't cover don't count toward it. (Source: CMS, medicare.gov.)
For context: the cap was $2,000 in 2025 and $2,100 in 2026, and it is indexed to rise slowly over time. The maximum Part D deductible allowed is $615 in 2026 and $700 in 2027, though many plans set theirs lower.
The "donut hole" is gone — for good
If you've been on Medicare for a while, you probably remember the coverage gap, better known as the donut hole. That was the awkward middle stretch where you suddenly paid more once your drug spending crossed a certain line, then less again after you hit "catastrophic" coverage.
That gap was eliminated in 2025. Part D now has 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, and your plan pays the rest. 3. Catastrophic coverage — once your out-of-pocket spending hits $2,400 in 2027, you pay nothing more for covered drugs the rest of the year.
Simpler to follow, and much easier to plan around.
The Medicare Prescription Payment Plan
Hitting the cap is good news, but $2,400 in January or February can still hurt if your medications are expensive up front. That's where the Medicare Prescription Payment Plan comes in.
This is a free, optional program. Instead of paying the pharmacy directly for your share at pickup, you can choose to have those costs billed to you in monthly installments spread across the rest of the calendar year. You still owe the same total — the plan doesn't lower your costs — but it smooths the timing.
A few things to know:
- You sign up through your Part D or Medicare Advantage drug plan, not through Medicare directly.
- You can opt in before the year starts or at any point during the year.
- It tends to help most people who face a big drug bill early in the year. If your drug costs are low and steady, monthly billing may not be worth the paperwork.
Medicare has a fact sheet on the payment plan at medicare.gov if you want to see whether it fits your situation.
What this means locally
Raleigh sits in Wake County, and like the rest of North Carolina, Wake County has a wide selection of stand-alone Part D plans and Medicare Advantage plans that include drug coverage. The exact number of plans available changes each year as carriers file with CMS.
The important point for 2027: the $2,400 cap and the three-phase design are the same in every Part D plan nationwide. They're set by federal law, not by your carrier. What varies plan to plan is the formulary (which drugs are covered), the pharmacy network, the deductible, and the copays before you hit the cap. That's why comparing plans on your specific medication list still matters, even with the cap in place.
The dates to circle
- October 15 – December 7, 2026: Medicare Annual Enrollment Period. This is when you can join, switch, or drop a Part D or Medicare Advantage plan for 2027.
- January 1, 2027: The updated Part D cap of $2,400 takes effect.
- January 1 – March 31, 2027: 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.
One more figure to keep on your radar: 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 (higher for joint filers). It's based on your tax return from two years earlier.
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 Wake County
(MA penetration in Wake 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”) was eliminated in 2025 (three phases now). There's 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 my drug isn't on my plan's formulary, does what I pay count toward the cap?
Do I have to sign up for the Prescription Payment Plan?
- CMS — Medicare Part D program rules (medicare.gov)
For personalized answers, contact Medicare.gov, 1-800-MEDICARE, or your local SHIP.